Provider Demographics
NPI:1689495855
Name:NUTRITION GENOME
Entity type:Organization
Organization Name:NUTRITION GENOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:JESS
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:541-797-3036
Mailing Address - Street 1:395 SW BLUFF DR STE 10
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1670
Mailing Address - Country:US
Mailing Address - Phone:541-797-3036
Mailing Address - Fax:
Practice Address - Street 1:395 SW BLUFF DR STE 10
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1670
Practice Address - Country:US
Practice Address - Phone:541-797-3036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics