Provider Demographics
NPI:1689031460
Name:ARIZONA NUTRITION CONSULTANTS, LLC
Entity Type:Organization
Organization Name:ARIZONA NUTRITION CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:GWENDELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,CNSC
Authorized Official - Phone:623-759-1531
Mailing Address - Street 1:PO BOX 6274
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-6274
Mailing Address - Country:US
Mailing Address - Phone:623-759-1531
Mailing Address - Fax:
Practice Address - Street 1:22026 N 103RD LN
Practice Address - Street 2:# 353
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2681
Practice Address - Country:US
Practice Address - Phone:623-759-1531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty