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General NPI Number Information
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NPI Number | 1609378595
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Entity Type | Organization
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Legal Business Name | STAMINA NUTRITION, PLLC
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 5320 FOSTER LN APT B
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City | BELGRADE
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State | MT
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Zip | 59714-8649
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Country | US
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Telephone | 406-855-1965
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Fax |
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Provider Business Mailing Address
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Address Line | 5320 FOSTER LN APT B
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City | BELGRADE
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State | MT
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Zip | 59714-8649
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Country | US
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Telephone | 406-855-1965
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Fax |
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Authorized Official
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Title or Position | OWNER, REGISTERED DIETITIAN
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Name | RACHEL PATRICK
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Credential | RDN
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Telephone | 406-855-1965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86035331
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License Number State | MT
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