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Organization
NORTH IDAHO WEIGHT LOSS, LLC.
Active
Organization
NORTH IDAHO WEIGHT LOSS, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY J BURCIAGA (FUNCTIONAL NUTRITIONIST/OWNER)
(805) 888-7077
Entity
Organization
Contact information
Practice address
118 N 7TH ST STE C12, COEUR D ALENE, ID 83814-2709
(208) 274-3611
Mailing address
118 N 7TH ST STE C12, COEUR D ALENE, ID 83814-2709
(208) 274-3611
Taxonomy
Speciality
Code
Description
License number
State
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
Primary
—
NULL
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
Primary
—
—
Other
Enumeration date
01/05/2020
Last updated
01/05/2020
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