Provider Demographics
NPI:1548744485
Name:NUTRITION EDUCATION SPECIALISTS LLC
Entity Type:Organization
Organization Name:NUTRITION EDUCATION SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROBERS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:833-366-3338
Mailing Address - Street 1:530 E MCDOWELL RD # 107-488
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1549
Mailing Address - Country:US
Mailing Address - Phone:883-366-3338
Mailing Address - Fax:833-450-5557
Practice Address - Street 1:9009 S 14TH WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-7983
Practice Address - Country:US
Practice Address - Phone:833-366-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty