MEDICARE: NOURISHED PEDIATRICS LLC

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

General Provider Information

NPI Number	:	1831985332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURISHED PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	8600 E ALAMEDA AVE APT 13-103
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-1187
Country	:	US
Telephone Number	:	262-501-4377
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 E ALAMEDA AVE APT 13-103
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-1187
Country	:	US
Telephone Number	:	262-501-4377
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIELLE ZOLD
Credential	:
Telephone Number	:	262-501-4377

Provider Enumeration Date	:	04/19/2025
Last Update Date	:	04/19/2025

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Directions to “NOURISHED PEDIATRICS LLC ” Practice Location

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