Provider Demographics
NPI:1134745631
Name:FEEDING BLISS PLLC
Entity type:Organization
Organization Name:FEEDING BLISS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:DILLON
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:602-730-5484
Mailing Address - Street 1:1844 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-3914
Mailing Address - Country:US
Mailing Address - Phone:602-730-5484
Mailing Address - Fax:833-518-3410
Practice Address - Street 1:1844 N 38TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-3914
Practice Address - Country:US
Practice Address - Phone:602-730-5484
Practice Address - Fax:833-518-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1740708205Medicaid