| Organization Name: | PRUDENT-LIFESTYLES NUTRITION SERVICES, INC. |
| NPI Number: | 1124228275 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TONJA MARIA STALLINGS (DIETITIAN) |
| Mailing Address: | 17570 San Rosa Blvd Lathrup Village |
| State: | MI US |
| Postal Code: | 480762715 |
| Phone Number: | 2488664967 |
| Fax Number: | 2485595081 |
| NPI Enumeration Date: | 07/18/2007 |
| NPI Last Update Date: | 08/06/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1006X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Metabolic |
| Taxonomy Definition: | |