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General NPI Number Information
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NPI Number | 1912525445
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Entity Type | Organization
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Legal Business Name | SUNRISE NUTRITION SERVICES, LLC
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 2942 N 24TH ST STE 114
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City | PHOENIX
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State | AZ
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Zip | 85016-7849
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Country | US
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Telephone | 505-728-6377
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Fax |
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Provider Business Mailing Address
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Address Line | 2942 N 24TH ST. SUITE # 114
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City | PHOENIX
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State | AZ
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Zip | 85016
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Country | US
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Telephone | 505-728-6377
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Fax |
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Authorized Official
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Title or Position | OWNER, REGISTERED DIETITIAN
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Name | JESSICA LEIGH QUINLAN
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Credential | MPH, RD, LD
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Telephone | 505-728-6377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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