Provider Demographics
NPI:1497270854
Name:NOURISHED ROOTS NUTRITION
Entity Type:Organization
Organization Name:NOURISHED ROOTS NUTRITION
Other - Org Name:NOURISHED ROOTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:973-901-5081
Mailing Address - Street 1:523 E 12TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2546
Mailing Address - Country:US
Mailing Address - Phone:973-901-5081
Mailing Address - Fax:303-209-8482
Practice Address - Street 1:523 E 12TH AVE APT 2
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2546
Practice Address - Country:US
Practice Address - Phone:973-901-5081
Practice Address - Fax:303-209-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty