MEDICARE: CUTTING EDGE NUTRITION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1225892086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUTTING EDGE NUTRITION LLC

Provider Business Mailing Address
First Line	:	7240 BRENTFORD DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3091
Country	:	US
Telephone Number	:	719-351-9671
Fax Number	:

Provider Business Practice Location Address
First Line	:	7240 BRENTFORD DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3091
Country	:	US
Telephone Number	:	719-351-9671
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MICHELLE ARCHULETA
Credential	:	RD
Telephone Number	:	719-351-9671

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/12/2024

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