Provider Demographics
NPI:1134984933
Name:509 NUTRITION & DIABETES CARE, PLLC
Entity type:Organization
Organization Name:509 NUTRITION & DIABETES CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-569-7782
Mailing Address - Street 1:1710 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:E WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4231
Mailing Address - Country:US
Mailing Address - Phone:702-569-7782
Mailing Address - Fax:
Practice Address - Street 1:1737 N WENATCHEE AVE STE E
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1189
Practice Address - Country:US
Practice Address - Phone:702-569-7782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty