Provider Demographics
NPI:1982111464
Name:DIABETES AND NUTRITION CONSULTANTS, LLC
Entity Type:Organization
Organization Name:DIABETES AND NUTRITION CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ARMATTA
Authorized Official - Suffix:
Authorized Official - Credentials:LD,RD,CDE
Authorized Official - Phone:337-207-9343
Mailing Address - Street 1:15455 MANCHESTER RD UNIT 13
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63022-5002
Mailing Address - Country:US
Mailing Address - Phone:337-207-9343
Mailing Address - Fax:866-438-4042
Practice Address - Street 1:267 CARMEL WOODS DR
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63021-4715
Practice Address - Country:US
Practice Address - Phone:337-207-9343
Practice Address - Fax:337-207-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017035075133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty