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General NPI Number Information
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NPI Number | 1659195857
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Entity Type | Organization
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Legal Business Name | RADISH NUTRITION LLC
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 212 S 11TH ST STE 4B
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4000
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Country | US
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Telephone | 925-818-9399
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Fax |
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Provider Business Mailing Address
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Address Line | 2915 E FERNAN CT
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City | COEUR D ALENE
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State | ID
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Zip | 83814-5803
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Country | US
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Telephone | 925-818-9399
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA MEGHAN KONEGNI
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Credential | MS, RD, CSR, LD
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Telephone | 925-818-9399
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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 |
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License Number State |
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