Individual
STEPHANIE NICOLE PUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
801 POLE LINE RD W, TWIN FALLS, ID 83301-5810
(208) 814-1016
(208) 814-1931
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
D-1209
ID
Other
Enumeration date
11/28/2022
Last updated
03/26/2025
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