Provider Demographics
NPI:1326506866
Name:BALANCE AND NOURISH, LLC
Entity Type:Organization
Organization Name:BALANCE AND NOURISH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:907-821-1340
Mailing Address - Street 1:97 EICHNER AVE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-9033
Mailing Address - Country:US
Mailing Address - Phone:907-821-1340
Mailing Address - Fax:
Practice Address - Street 1:540 WATER ST STE 101
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6378
Practice Address - Country:US
Practice Address - Phone:907-821-1340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty