Healthcare Provider Details

I. General information

NPI: 1275177560
Provider Name (Legal Business Name): TRAVELING MAMA ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S LEWIS AND CLARK TRL
WHITEHALL MT
59759-9547
US

IV. Provider business mailing address

67 S LEWIS AND CLARK TRL
WHITEHALL MT
59759-9547
US

V. Phone/Fax

Practice location:
  • Phone: 406-209-3995
  • Fax: 406-451-0551
Mailing address:
  • Phone: 406-209-3995
  • Fax: 406-451-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMY HORNER
Title or Position: OWNER
Credential: MPH, RD, CLC, RDN
Phone: 406-209-3995