Healthcare Provider Details

I. General information

NPI: 1235648775
Provider Name (Legal Business Name): SUMMIT PEAK NUTRITION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 BIG BEAR CIR
SEDALIA CO
80135-4433
US

IV. Provider business mailing address

PO BOX 732
SEDALIA CO
80135-0732
US

V. Phone/Fax

Practice location:
  • Phone: 720-459-0913
  • Fax:
Mailing address:
  • Phone: 720-459-0913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE THOMSON
Title or Position: REGISTERED DIETITIAN/OWNER
Credential: MS, RDN
Phone: 720-459-0913