MEDICARE: NECTAR NUTRITION CONSULTING 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	:	1831613785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NECTAR NUTRITION CONSULTING LLC

Provider Business Mailing Address
First Line	:	373 BLAIR PARK RD UNIT 201
Second Line	:
City	:	WILLISTON
State	:	VT
Zip	:	05495-8056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	373 BLAIR PARK RD UNIT 201
Second Line	:
City	:	WILLISTON
State	:	VT
Zip	:	05495-8056
Country	:	US
Telephone Number	:	802-448-5006
Fax Number	:

Authorized Official
Title or Position	:	DIETITIAN
Name	:	CARLY GONET
Credential	:
Telephone Number	:	802-448-5006

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	08/02/2017

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