Provider Demographics
NPI:1306145925
Name:ENLIGHTENMENT NUTRITION CONSULTING
Entity type:Organization
Organization Name:ENLIGHTENMENT NUTRITION CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:970-281-5620
Mailing Address - Street 1:3131 CONESTOGA CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2715
Mailing Address - Country:US
Mailing Address - Phone:970-281-5620
Mailing Address - Fax:
Practice Address - Street 1:3131 CONESTOGA CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2715
Practice Address - Country:US
Practice Address - Phone:970-281-5620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00886808261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMT0646Medicare PIN