| Nutrition Dejunked Llc | |
|
3350 W Americana Ter Ste 215, Boise, ID 83706-2545 | |
| (208) 629-2441 | |
| Not Available |
| Full Name | Nutrition Dejunked Llc |
|---|---|
| Type | Facility |
| Speciality | Dietitian, Registered |
| Location | 3350 W Americana Ter Ste 215, Boise, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437779469 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 133V00000X | Dietitian, Registered | (* (Not Available)) | Primary |
| Provider Name | Kathryn Willis Callahan |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1356992937 PECOS PAC ID: 1052732070 Enrollment ID: I20200529002657 |
| Mailing Address | Practice Location Address |
|---|---|
| Nutrition Dejunked Llc 3350 W Americana Ter Ste 215, Boise, ID 83706-2545 Ph: (208) 629-2441 | Nutrition Dejunked Llc 3350 W Americana Ter Ste 215, Boise, ID 83706-2545 Ph: (208) 629-2441 |
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