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General NPI Number Information
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NPI Number | 1104043553
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Entity Type | Organization
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Legal Business Name | ESSENTIAL NUTRITION LLC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 4410 ARAPAHOE AVE SUITE 110
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City | BOULDER
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State | CO
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Zip | 80303-1135
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Country | US
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Telephone | 720-315-0051
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Fax | 720-306-4644
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Provider Business Mailing Address
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Address Line | 823 W. MULBERRY ST.
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City | LOUISVILLE
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State | CO
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Zip | 80027
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Country | US
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Telephone | 720-284-1581
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Fax | 720-306-4644
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MS. LISA MARIE LANZANO
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Credential | MS, RDN
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Telephone | 720-284-1581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 838488
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State | NULL
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