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General NPI Number Information
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NPI Number | 1629424643
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Entity Type | Organization
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Legal Business Name | NORTHWEST NUTRITION CONSULTATION
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 140 CYCLONE DR
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City | KALISPELL
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State | MT
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Zip | 59901-7163
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Country | US
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Telephone | 406-471-9998
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Fax |
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Provider Business Mailing Address
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Address Line | 140 CYCLONE DR
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City | KALISPELL
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State | MT
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Zip | 59901-7163
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Country | US
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Telephone | 406-471-9998
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY A DUTY
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Credential | RD
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Telephone | 406-471-9998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 516
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License Number State | MT
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