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General NPI Number Information
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NPI Number | 1306145925
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Entity Type | Organization
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Legal Business Name | ENLIGHTENMENT NUTRITION CONSULTING
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 3131 CONESTOGA CT
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City | FORT COLLINS
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State | CO
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Zip | 80526-2715
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Country | US
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Telephone | 970-281-5620
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 CONESTOGA CT
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City | FORT COLLINS
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State | CO
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Zip | 80526-2715
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Country | US
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Telephone | 970-281-5620
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN/OWNER
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Name | NICOLE ECKMAN
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Credential | RD
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Telephone | 970-281-5620
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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 | 00886808
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License Number State | NJ
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