Provider Demographics
NPI:1780037457
Name:ADVANCED NUTRITION CONSULTANTS, LLC
Entity Type:Organization
Organization Name:ADVANCED NUTRITION CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NUTRITION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:610-420-1022
Mailing Address - Street 1:190 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1385
Mailing Address - Country:US
Mailing Address - Phone:610-229-9060
Mailing Address - Fax:610-409-9882
Practice Address - Street 1:190 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 155
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1385
Practice Address - Country:US
Practice Address - Phone:610-229-9060
Practice Address - Fax:610-409-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001659133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty