Organization
WELLNESS IMPACT NUTRITION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEENA M LAJOIE MS, RDN, LD (OWNER/REGISTERED DIETITIAN)
(208) 250-5657
Entity
Organization
Contact information
Practice address
1013 E WINDING CREEK DR, SUITE 102, EAGLE, ID 83616-7060
(208) 250-5657
(208) 433-9424
Mailing address
3797 N CROFT WAY, EAGLE, ID 83616-2265
(208) 250-5657
(208) 433-9424
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-682
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588936710
—
ID
Enumeration date
01/29/2015
Last updated
02/11/2016
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