Provider Demographics
NPI:1811661275
Name:BLAKELY NUTRITION AND HEALTH EDUCATION CONSULTING LLC
Entity type:Organization
Organization Name:BLAKELY NUTRITION AND HEALTH EDUCATION CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:MONET
Authorized Official - Last Name:BLAKELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-348-9308
Mailing Address - Street 1:8724 BRANDYWINE RD
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2878
Mailing Address - Country:US
Mailing Address - Phone:330-348-9308
Mailing Address - Fax:
Practice Address - Street 1:8724 BRANDYWINE RD
Practice Address - Street 2:
Practice Address - City:SAGAMORE HILLS
Practice Address - State:OH
Practice Address - Zip Code:44067-2878
Practice Address - Country:US
Practice Address - Phone:330-348-9308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty