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NPI Code Detail

MEDICARE: NOURISHED NUTRITION COUNSELING

MEDICARE: NOURISHED NUTRITION COUNSELING
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
1133V00000XRegistered Dietitian86066058AZ

General Provider Information

NPI Number : 1639684483
Entity Type Code : Organization
Provider Name (Legal Business Name) : NOURISHED NUTRITION COUNSELING
Provider Business Mailing Address
First Line : 7301 N 16TH ST STE 102
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-5266
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7301 N 16TH ST STE 102
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-5266
Country : US
Telephone Number : 480-688-1779
Fax Number :
Authorized Official
Title or Position : REGISTERED DIETITIAN NUTRITIONIST
Name : DEMI KEEZER
Credential : RDN
Telephone Number : 480-688-1779
Provider Enumeration Date : 12/01/2017
Last Update Date : 12/08/2017

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Directions to “NOURISHED NUTRITION COUNSELING ” Practice Location

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