Healthcare Provider Details

I. General information

NPI: 1083925176
Provider Name (Legal Business Name): DGROUP CONSULTING SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 MARGARET ST STE 302 PMB 342
JACKSONVILLE FL
32204-3868
US

IV. Provider business mailing address

1650 MARGARET ST STE 302 PMB 342
JACKSONVILLE FL
32204-3868
US

V. Phone/Fax

Practice location:
  • Phone: 904-859-1425
  • Fax:
Mailing address:
  • Phone: 904-859-1425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DORETTE MARIE NYSEWANDER
Title or Position: PRESIDENT
Credential: EDD
Phone: 904-859-1425