Healthcare Provider Details

I. General information

NPI: 1316205016
Provider Name (Legal Business Name): SIMPLE NUTRITION SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 FARTHING DR
COLORADO SPRINGS CO
80906-5969
US

IV. Provider business mailing address

4820 FARTHING DR
COLORADO SPRINGS CO
80906-5969
US

V. Phone/Fax

Practice location:
  • Phone: 719-375-8645
  • Fax:
Mailing address:
  • Phone: 719-375-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number956457
License Number State

VIII. Authorized Official

Name: ANDREA HARRINGTON ULRICH
Title or Position: OWNER
Credential: MS, RD
Phone: 719-375-8645