Healthcare Provider Details

I. General information

NPI: 1578386595
Provider Name (Legal Business Name): HAPPY TRAILS NUTRITION L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N MAIN ST
WHITE RIVER JUNCTION VT
05001-7056
US

IV. Provider business mailing address

108 N MAIN ST
WHITE RIVER JUNCTION VT
05001-7056
US

V. Phone/Fax

Practice location:
  • Phone: 603-802-3988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MEIJER
Title or Position: OWNER
Credential: PHD, RD
Phone: 603-802-3988