Individual
MADISON STAINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10727 DOMAIN DR APT 177, AUSTIN, TX 78758-5044
(404) 313-8389
Mailing address
10727 DOMAIN DR APT 177, AUSTIN, TX 78758-5044
(404) 313-8389
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
171400000X
Health & Wellness Coach
—
—
Other
Enumeration date
01/24/2023
Last updated
01/24/2023
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