Provider Demographics
NPI:1942957816
Name:INTENTFUL NUTRITION LLC
Entity Type:Organization
Organization Name:INTENTFUL NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:BUSA
Authorized Official - Last Name:CZARNECKI
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:315-663-1028
Mailing Address - Street 1:7404 METZGER AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99506-2020
Mailing Address - Country:US
Mailing Address - Phone:315-663-1028
Mailing Address - Fax:907-215-6060
Practice Address - Street 1:205 E BENSON BLVD STE 501
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4019
Practice Address - Country:US
Practice Address - Phone:315-663-1028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty