Provider Demographics
NPI:1104043553
Name:ESSENTIAL NUTRITION LLC
Entity type:Organization
Organization Name:ESSENTIAL NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LANZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:720-284-1581
Mailing Address - Street 1:823 W. MULBERRY ST.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027
Mailing Address - Country:US
Mailing Address - Phone:720-284-1581
Mailing Address - Fax:720-306-4644
Practice Address - Street 1:4410 ARAPAHOE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1135
Practice Address - Country:US
Practice Address - Phone:720-315-0051
Practice Address - Fax:720-306-4644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIAL NUTRITION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
CO838488261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty