Healthcare Provider Details

I. General information

NPI: 1275195992
Provider Name (Legal Business Name): SUNRISE NUTRITION CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 N OLD US HIGHWAY 81
HESSTON KS
67062-9406
US

IV. Provider business mailing address

109 E PINE ST
HESSTON KS
67062-9055
US

V. Phone/Fax

Practice location:
  • Phone: 316-217-2984
  • Fax: 620-869-9032
Mailing address:
  • Phone: 316-217-2984
  • Fax: 620-869-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAULA MILLER
Title or Position: REGISTERED DIETITIAN
Credential: RD
Phone: 316-217-2984