Healthcare Provider Details

I. General information

NPI: 1740708205
Provider Name (Legal Business Name): COURTNEY DILLON BLISS MS, RDN, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 07/21/2022
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 N 38TH ST
PHOENIX AZ
85008-3914
US

IV. Provider business mailing address

1844 N 38TH ST
PHOENIX AZ
85008-3914
US

V. Phone/Fax

Practice location:
  • Phone: 702-338-8635
  • Fax:
Mailing address:
  • Phone: 702-338-8635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: