# NORTH IDAHO WEIGHT LOSS, LLC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134768393
- **Authorized official:** PENNY J BURCIAGA (FUNCTIONAL NUTRITIONIST/OWNER)
- **Authorized official phone:** (805) 888-7077

## Contact information

- **Practice address:** 118 N 7TH ST STE C12, COEUR D ALENE, ID 83814-2709
- **Practice address phone:** (208) 274-3611
- **Mailing address:** 118 N 7TH ST STE C12, COEUR D ALENE, ID 83814-2709
- **Mailing address phone:** (208) 274-3611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1201X | Obesity and Weight Management Nutrition Registered Dietitian | — | NULL | Yes |
| 133VN1201X | Obesity and Weight Management Nutrition Registered Dietitian | — | — | Yes |

## Other

- **Enumeration date:** 01/05/2020
- **Last updated:** 01/05/2020