Provider Demographics
NPI:1710350012
Name:PARTNERS IN NUTRITION, LLC
Entity Type:Organization
Organization Name:PARTNERS IN NUTRITION, LLC
Other - Org Name:JACQUELYN NIELSEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDE
Authorized Official - Phone:970-622-9997
Mailing Address - Street 1:1907 HILLROSE DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3438
Mailing Address - Country:US
Mailing Address - Phone:970-622-9997
Mailing Address - Fax:970-667-8383
Practice Address - Street 1:1101 OAKRIDGE DR
Practice Address - Street 2:SUITE B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5528
Practice Address - Country:US
Practice Address - Phone:970-622-9997
Practice Address - Fax:970-667-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COR708546261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC452618Medicare UPIN