Provider Demographics
NPI:1457982480
Name:DAMZIL NUTRITION COUNSELING, LLC
Entity Type:Organization
Organization Name:DAMZIL NUTRITION COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIZETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUBAY COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:503-457-4923
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OR
Mailing Address - Zip Code:97032-0284
Mailing Address - Country:US
Mailing Address - Phone:503-457-4923
Mailing Address - Fax:503-376-6714
Practice Address - Street 1:3795 RIVER RD N STE D
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4826
Practice Address - Country:US
Practice Address - Phone:503-457-4923
Practice Address - Fax:503-376-6714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty