Organization
OPEN CONCEPT NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE RUTH NELLESSEN RDN (SOLE MEMBER)
(715) 308-3895
Entity
Organization
Contact information
Practice address
W2713 730TH AVE, SPRING VALLEY, WI 54767-8512
(715) 308-3895
Mailing address
W2713 730TH AVE, SPRING VALLEY, WI 54767-8512
(715) 308-3895
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861904534
NPI
—
Enumeration date
06/08/2021
Last updated
06/08/2021
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