Individual
ANNIKA LENORE DOUGHERTY IMELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, IBCLC
Contact information
Practice address
141 ASPEN VIEW RD, POLARIS, MT 59746
(415) 606-9558
Mailing address
PO BOX 460458, POLARIS, MT 59746-0458
(415) 606-9558
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
MED-NUT-LIC-125402
MT
174N00000X
Lactation Consultant (Non-RN)
L-21954
—
Other
Enumeration date
04/11/2023
Last updated
01/03/2025
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