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General NPI Number Information
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NPI Number | 1609487008
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Entity Type | Individual
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Provider Name | ANDI M COFFEE NUTRITIONIST
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Gender | Female
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1928 W ST EXUPERY DR
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City | ANTHEM
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State | AZ
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Zip | 85086-3623
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Country | US
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Telephone | 602-478-3709
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Fax |
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Provider Business Mailing Address
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Address Line | 3613 W SOUSA CT
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City | ANTHEM
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State | AZ
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Zip | 85086-6022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DX5894
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | ND11884
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 18329
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #6
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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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