Organization
POSITIVELY NOURISHED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE NICOLE PUGH RD (OWNER, REGISTERED DIETITIAN)
(208) 607-5864
Entity
Organization
Contact information
Practice address
1153 TERRA AVE, TWIN FALLS, ID 83301-4734
(208) 607-5864
Mailing address
1153 TERRA AVE, TWIN FALLS, ID 83301-4734
(208) 607-5864
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528778933
INDIVIDUAL NPI FOR STEPHANIE PUGH, OWNER
ID
Enumeration date
05/09/2025
Last updated
05/09/2025
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