Healthcare Provider Details

I. General information

NPI: 1255408951
Provider Name (Legal Business Name): EAT WELL NUTRITION THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 1/2 N CEDAR AVE
OWATONNA MN
55060-2392
US

IV. Provider business mailing address

PO BOX 913
OWATONNA MN
55060-0913
US

V. Phone/Fax

Practice location:
  • Phone: 507-390-0229
  • Fax:
Mailing address:
  • Phone: 507-390-0229
  • Fax: 507-451-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberN122
License Number StateMN

VIII. Authorized Official

Name: LOUANNE P. KAUPA
Title or Position: OWNER
Credential: RDN, LN
Phone: 507-390-0229