=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215123666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORTON NUTRITION CONSULTING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2007
-----------------------------------------------------
Last Update Date | 09/20/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5504 LITTLE RD
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-858-4711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10105 FOX SQUIRREL DR
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34654-3576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-858-4711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LUGENE A MORTON-QUINN
-----------------------------------------------------
Credential | M.S., R.D., L.D.N.
-----------------------------------------------------
Telephone | 727-858-4711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | ND2387
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------