Healthcare Provider Details

I. General information

NPI: 1730578246
Provider Name (Legal Business Name): AFFILIATED NUTRITION CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8108 E MICHELLE DR
SCOTTSDALE AZ
85255-5404
US

IV. Provider business mailing address

8108 E MICHELLE DR
SCOTTSDALE AZ
85255-5404
US

V. Phone/Fax

Practice location:
  • Phone: 480-251-1303
  • Fax: 480-393-3072
Mailing address:
  • Phone: 480-251-1303
  • Fax: 480-393-3072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA KANDELL KOTLER
Title or Position: OWNER
Credential: MS, RDN, CLE, CSP
Phone: 480-251-1303