Organization
GREAT BASIN NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JODI PETTERSEN RDN, LD (OWNER)
(775) 720-3490
Entity
Organization
Contact information
Practice address
783 BASQUE WAY STE 103, CARSON CITY, NV 89706-7981
(775) 720-3490
(775) 245-2867
Mailing address
783 BASQUE WAY STE 103, CARSON CITY, NV 89706-7981
(775) 720-3490
(775) 245-2867
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
12/21/2018
Last updated
12/21/2018
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