Organization
MY SIGNATURE NUTRITION, LLC
Active
Organization
MY SIGNATURE NUTRITION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SARA UPSON M.ED, RD, LD (OWNER)
(903) 312-8906
Entity
Organization
Contact information
Practice address
5620 OLD BULLARD RD, SUITE 125, TYLER, TX 75703-4358
(903) 312-8906
Mailing address
5620 OLD BULLARD RD, SUITE 125, TYLER, TX 75703-4358
(903) 312-8906
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT82055
TX
Other
Enumeration date
10/09/2014
Last updated
10/09/2014
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