Provider Demographics
NPI:1568710002
Name:BETSY CRISAFULLI NUTRITION
Entity Type:Organization
Organization Name:BETSY CRISAFULLI NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:FISHER
Authorized Official - Last Name:CRISAFULLI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDN
Authorized Official - Phone:919-630-2890
Mailing Address - Street 1:251 S END RD
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1822
Mailing Address - Country:US
Mailing Address - Phone:919-630-2890
Mailing Address - Fax:
Practice Address - Street 1:100 QUEEN ST
Practice Address - Street 2:SUITE 4G
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2052
Practice Address - Country:US
Practice Address - Phone:860-863-4601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT962261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center