Provider Demographics
NPI:1912726308
Name:NOURISH NUTRITION CO
Entity type:Organization
Organization Name:NOURISH NUTRITION CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:CLYDE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:385-215-9458
Mailing Address - Street 1:2943 PARKWAY BLVD
Mailing Address - Street 2:PMB 39
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119
Mailing Address - Country:US
Mailing Address - Phone:385-215-9458
Mailing Address - Fax:385-259-7761
Practice Address - Street 1:2943 PARKWAY BLVD
Practice Address - Street 2:PMB 39
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119
Practice Address - Country:US
Practice Address - Phone:385-215-9458
Practice Address - Fax:385-259-7761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty