Healthcare Provider Details

I. General information

NPI: 1104043553
Provider Name (Legal Business Name): ESSENTIAL NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 ARAPAHOE AVE SUITE 110
BOULDER CO
80303-1135
US

IV. Provider business mailing address

823 W. MULBERRY ST.
LOUISVILLE CO
80027
US

V. Phone/Fax

Practice location:
  • Phone: 720-315-0051
  • Fax: 720-306-4644
Mailing address:
  • Phone: 720-284-1581
  • Fax: 720-306-4644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number838488
License Number StateCO

VIII. Authorized Official

Name: MS. LISA MARIE LANZANO
Title or Position: MANAGING MEMBER
Credential: MS, RDN
Phone: 720-284-1581