MEDICARE: EZ NUTRITION CONSULTING, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	688	NE

General Provider Information

NPI Number	:	1457744500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZ NUTRITION CONSULTING, PC

Provider Business Mailing Address
First Line	:	3763 39TH AVE
Second Line	:	SUITE 400
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4504
Country	:	US
Telephone Number	:	402-563-0312
Fax Number	:	402-563-0315

Provider Business Practice Location Address
First Line	:	3763 39TH AVE
Second Line	:	SUITE 400
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4504
Country	:	US
Telephone Number	:	402-563-0312
Fax Number	:	402-563-0315

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NORMA E FARLEY-ZOUCHA
Credential	:	RD, LMNT
Telephone Number	:	402-563-0312

Provider Enumeration Date	:	03/13/2015
Last Update Date	:	03/13/2015

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