Provider Demographics
NPI:1659913309
Name:NOURISHED LLC
Entity Type:Organization
Organization Name:NOURISHED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BENICH
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:469-288-3407
Mailing Address - Street 1:833 CANONGATE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-8012
Mailing Address - Country:US
Mailing Address - Phone:469-288-3407
Mailing Address - Fax:
Practice Address - Street 1:833 CANONGATE DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-8012
Practice Address - Country:US
Practice Address - Phone:469-288-3407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty