Healthcare Provider Details

I. General information

NPI: 1447914346
Provider Name (Legal Business Name): SELF-WORTH NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 MEADOW RD
NEW BOSTON NH
03070-3818
US

IV. Provider business mailing address

236 MEADOW RD
NEW BOSTON NH
03070-3818
US

V. Phone/Fax

Practice location:
  • Phone: 503-265-9396
  • Fax:
Mailing address:
  • Phone: 503-265-9396
  • 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: AMY JEAN ELDRIDGE
Title or Position: OWNER
Credential: MS, RDN, LDN
Phone: 503-265-9396