Healthcare Provider Details

I. General information

NPI: 1255110813
Provider Name (Legal Business Name): NUTRITIONAL ASCENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9235 S REDWASH RD
JENSEN UT
84035
US

IV. Provider business mailing address

9235 S REDWASH RD
JENSEN UT
84035
US

V. Phone/Fax

Practice location:
  • Phone: 844-233-1888
  • Fax:
Mailing address:
  • Phone: 844-233-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: JOANNE LLAURY-MARKS
Title or Position: NUTRITIONIST
Credential:
Phone: 303-621-6948