Organization
PRAIRIE VIEW CREATIONS LLC
Active
Other names
Healthy Transitions For Life
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HETHERWICK MS, RD (REGISTERED DIETITIAN NUTRITIONIST)
(928) 772-8652
Entity
Organization
Contact information
Practice address
8508 N PRAIRIE VW, PRESCOTT VALLEY, AZ 86315-9089
(928) 772-8652
(928) 772-8078
Mailing address
PO BOX 10214, PRESCOTT, AZ 86304-0214
(928) 772-8652
(928) 772-8078
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
133VN1004X
Pediatric Nutrition Registered Dietitian
—
—
133VN1005X
Renal Nutrition Registered Dietitian
—
—
133VN1006X
Metabolic Nutrition Registered Dietitian
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
488506
—
AZ
Enumeration date
02/27/2019
Last updated
11/03/2020
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