Provider Demographics
NPI:1073995015
Name:UPSTATE NUTRITION CONSULTANTS, INC.
Entity Type:Organization
Organization Name:UPSTATE NUTRITION CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:864-915-2913
Mailing Address - Street 1:108 E POINSETT ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-3404
Mailing Address - Country:US
Mailing Address - Phone:864-915-2640
Mailing Address - Fax:864-968-9856
Practice Address - Street 1:108 E POINSETT ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-3404
Practice Address - Country:US
Practice Address - Phone:864-915-2640
Practice Address - Fax:864-968-9856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC378133V00000X
SC1365133V00000X
SC1372133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty