Organization
GRAND TRAVERSE NUTRITION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MIRANDA MONROE RDN (MEMBER/OWNER)
(231) 632-1522
Entity
Organization
Contact information
Practice address
800 COTTAGEVIEW DR, SUITE 1076, TRAVERSE CITY, MI 49684-2616
(231) 632-1522
Mailing address
PO BOX 6263, TRAVERSE CITY, MI 49696-6263
(231) 632-1522
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
851200
RDN - COMMISSION DIETETIC REGISTRATION
MI
Enumeration date
02/27/2014
Last updated
02/27/2014
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