Healthcare Provider Details

I. General information

NPI: 1841115003
Provider Name (Legal Business Name): NUTRITHRIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 S CALHOUN PL
STAR ID
83669-5310
US

IV. Provider business mailing address

680 S CALHOUN PL
STAR ID
83669-5310
US

V. Phone/Fax

Practice location:
  • Phone: 208-599-0341
  • Fax:
Mailing address:
  • Phone: 208-599-0341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: VANESSA ROJAS-BAUTISTA
Title or Position: FOUNDER
Credential: RDN
Phone: 208-599-0341