Provider Demographics
NPI:1184167074
Name:EMPOWER HEALTH BY NUTRITION PLLC
Entity type:Organization
Organization Name:EMPOWER HEALTH BY NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAINGO
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:928-380-1610
Mailing Address - Street 1:1210 W DAVIS WAY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1201
Mailing Address - Country:US
Mailing Address - Phone:928-380-1610
Mailing Address - Fax:928-774-8606
Practice Address - Street 1:1210 W DAVIS WAY
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1201
Practice Address - Country:US
Practice Address - Phone:928-380-1610
Practice Address - Fax:928-774-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty