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General NPI Number Information
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NPI Number | 1275195992
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Entity Type | Organization
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Legal Business Name | SUNRISE NUTRITION CONSULTING LLC
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 359 N OLD US HIGHWAY 81
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City | HESSTON
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State | KS
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Zip | 67062-9406
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Country | US
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Telephone | 316-217-2984
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Fax | 620-869-9032
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Provider Business Mailing Address
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Address Line | 109 E PINE ST
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City | HESSTON
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State | KS
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Zip | 67062-9055
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Country | US
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Telephone | 316-217-2984
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Fax | 620-869-9032
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | PAULA MILLER
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Credential | RD
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Telephone | 316-217-2984
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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 |
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License Number State |
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