Provider Demographics
NPI:1942053426
Name:MACKENZIE BLAIR NUTRITION COUNSELING
Entity Type:Organization
Organization Name:MACKENZIE BLAIR NUTRITION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:434-203-3004
Mailing Address - Street 1:14 GARFIELD AVE # 3
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-3306
Mailing Address - Country:US
Mailing Address - Phone:401-288-1043
Mailing Address - Fax:401-246-8128
Practice Address - Street 1:14 GARFIELD AVE # 3
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-3306
Practice Address - Country:US
Practice Address - Phone:401-288-1043
Practice Address - Fax:401-246-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty