Provider Demographics
NPI:1386966364
Name:NOURISHING DIRECTION INC
Entity type:Organization
Organization Name:NOURISHING DIRECTION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-597-1115
Mailing Address - Street 1:1250 S GLENDALE AVE
Mailing Address - Street 2:SUITE B PMB 102
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5642
Mailing Address - Country:US
Mailing Address - Phone:888-597-1115
Mailing Address - Fax:888-510-7888
Practice Address - Street 1:1029 W 3RD AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-1981
Practice Address - Country:US
Practice Address - Phone:888-597-1115
Practice Address - Fax:888-510-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK56352086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty