MEDICARE: SIMPLY NOURISHED NUTRITION 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1982457933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLY NOURISHED NUTRITION LLC

Provider Business Mailing Address
First Line	:	1958 S GRANT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 E TENNESSEE AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-4637
Country	:	US
Telephone Number	:	720-772-7120
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	ELLEN FREEMAN
Credential	:	MSN, RDN
Telephone Number	:	303-229-9840

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/09/2024

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Directions to “SIMPLY NOURISHED NUTRITION LLC ” Practice Location

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