Provider Demographics
NPI:1831985332
Name:NOURISHED PEDIATRICS LLC
Entity type:Organization
Organization Name:NOURISHED PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-501-4377
Mailing Address - Street 1:8600 E ALAMEDA AVE APT 13-103
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1187
Mailing Address - Country:US
Mailing Address - Phone:262-501-4377
Mailing Address - Fax:
Practice Address - Street 1:8600 E ALAMEDA AVE APT 13-103
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1187
Practice Address - Country:US
Practice Address - Phone:262-501-4377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty