Healthcare Provider Details

I. General information

NPI: 1174859607
Provider Name (Legal Business Name): A COACH FOR ME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2009
Last Update Date: 10/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 FLINTRIDGE DR STE 201
COLORADO SPRINGS CO
80918-4253
US

IV. Provider business mailing address

4740 FLINTRIDGE DR STE 201
COLORADO SPRINGS CO
80918-4253
US

V. Phone/Fax

Practice location:
  • Phone: 719-510-6313
  • Fax:
Mailing address:
  • Phone: 719-510-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: MRS. RANDEE PHYLLIS VAN NESS
Title or Position: OWNER
Credential:
Phone: 719-510-6313