Provider Demographics
NPI:1568093318
Name:AZALEA NUTRITION CONSULTING, LLC
Entity Type:Organization
Organization Name:AZALEA NUTRITION CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD
Authorized Official - Phone:251-637-4325
Mailing Address - Street 1:2557 S DURHAM DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-1742
Mailing Address - Country:US
Mailing Address - Phone:251-367-4325
Mailing Address - Fax:251-272-3832
Practice Address - Street 1:2557 S DURHAM DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-1742
Practice Address - Country:US
Practice Address - Phone:251-367-4325
Practice Address - Fax:251-272-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty