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General NPI Number Information
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NPI Number | 1255408951
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Entity Type | Organization
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Legal Business Name | EAT WELL NUTRITION THERAPY, LLC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 202 1/2 N CEDAR AVE
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City | OWATONNA
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State | MN
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Zip | 55060-2392
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Country | US
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Telephone | 507-390-0229
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 913
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City | OWATONNA
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State | MN
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Zip | 55060-0913
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Country | US
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Telephone | 507-390-0229
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Fax | 507-451-3322
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Authorized Official
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Title or Position | OWNER
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Name | LOUANNE P. KAUPA
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Credential | RDN, LN
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Telephone | 507-390-0229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | N122
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License Number State | MN
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