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Organization

GENESIS NUTRITION LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KAITLYN JOHNSON RD (REGISTERED DIETITIAN)
(307) 746-8353
Entity
Organization

Contact information

Practice address
7717 IVY LANE, WELLINGTON, CO 80549
(307) 746-8353
Mailing address
PO BOX 708, WELLINGTON, CO 80549-0708
(307) 746-8353

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary

Other

Enumeration date
12/23/2021
Last updated
12/23/2021
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