Healthcare Provider Details

I. General information

NPI: 1851663132
Provider Name (Legal Business Name): SALUBRIOUS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 PALMER ST SUITE A
MISSOULA MT
59808-1708
US

IV. Provider business mailing address

2685 PALMER ST SUITE A
MISSOULA MT
59808-1708
US

V. Phone/Fax

Practice location:
  • Phone: 406-543-8900
  • Fax:
Mailing address:
  • Phone: 406-543-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA KAY JENNINGS
Title or Position: OWNER
Credential: APRN
Phone: 406-543-8900