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General NPI Number Information
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NPI Number | 1497561625
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Entity Type | Organization
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Legal Business Name | EAT HEAL NOURISH LLC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 14631 SW MILLIKAN WAY
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City | BEAVERTON
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State | OR
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Zip | 97003-2999
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Country | US
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Telephone | 503-890-5139
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Fax |
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Provider Business Mailing Address
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Address Line | 2850 SW CEDAR HILLS BLVD # 2250
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City | BEAVERTON
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State | OR
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Zip | 97005-1354
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Country | US
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Telephone | 503-890-5139
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Fax |
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Authorized Official
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Title or Position | DIETITIAN
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Name | KOOSJE BOYD
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Credential |
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Telephone | 503-890-5139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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