Provider Demographics
NPI:1740708205
Name:BLISS, COURTNEY DILLON (MS, RDN, CNSC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DILLON
Last Name:BLISS
Suffix:
Gender:F
Credentials:MS, RDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:702-338-8635
Mailing Address - Fax:
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:702-338-8635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
86007759OtherCOMMISSION ON DIETETIC REGISTRATION