Healthcare Provider Details

I. General information

NPI: 1609378595
Provider Name (Legal Business Name): STAMINA NUTRITION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 FOSTER LN APT B
BELGRADE MT
59714-8649
US

IV. Provider business mailing address

5320 FOSTER LN APT B
BELGRADE MT
59714-8649
US

V. Phone/Fax

Practice location:
  • Phone: 406-855-1965
  • Fax:
Mailing address:
  • Phone: 406-855-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86035331
License Number StateMT

VIII. Authorized Official

Name: RACHEL PATRICK
Title or Position: OWNER, REGISTERED DIETITIAN
Credential: RDN
Phone: 406-855-1965