MEDICARE: EAT WELL NUTRITION THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1006X	Metabolic Nutrition Registered Dietitian	N122	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	118175	OTHER	MN	HEALTHPARTNERS
2	63-50011	OTHER	MN	MEDICA
3	136634	OTHER	MN	UCARE
4	342G5EA	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1255408951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAT WELL NUTRITION THERAPY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 913
Second Line	:
City	:	OWATONNA
State	:	MN
Zip	:	55060-0913
Country	:	US
Telephone Number	:	507-390-0229
Fax Number	:	507-451-3322

Provider Business Practice Location Address
First Line	:	207 W HOLLY ST
Second Line	:
City	:	OWATONNA
State	:	MN
Zip	:	55060-3959
Country	:	US
Telephone Number	:	507-390-0229
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CLINICIAN
Name	:	LOUANNE P. KAUPA
Credential	:	RDN, LN, CDCES
Telephone Number	:	507-390-0229

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	02/17/2026

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