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General NPI Number Information
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NPI Number | 1598318818
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Entity Type | Organization
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Legal Business Name | ACORN DIETETICS, LLC
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 906 10TH AVE
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City | NEW GLARUS
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State | WI
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Zip | 53574-9765
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Country | US
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Telephone | 704-608-6613
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Fax |
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Provider Business Mailing Address
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Address Line | 906 10TH AVE
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City | NEW GLARUS
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State | WI
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Zip | 53574-9765
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Country | US
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Telephone | 608-284-8642
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LIZA ORENGO
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Credential | MPH, RD, CSR
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Telephone | 608-284-8642
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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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