Provider Demographics
NPI:1457640146
Name:NUTRITION CONNECTION, INC
Entity Type:Organization
Organization Name:NUTRITION CONNECTION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUDWILL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:303-550-6390
Mailing Address - Street 1:950 S CHERRY ST
Mailing Address - Street 2:SUITE 412
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2699
Mailing Address - Country:US
Mailing Address - Phone:303-550-6390
Mailing Address - Fax:303-758-3872
Practice Address - Street 1:950 S CHERRY ST
Practice Address - Street 2:SUITE 412
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2699
Practice Address - Country:US
Practice Address - Phone:303-550-6390
Practice Address - Fax:303-758-3872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-03
Last Update Date:2011-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO377167133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty