Organization
IDAHO NUTRITION AND WELLNESS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELSEY L BERNIER MS, RD, LD, LMT (OWNER, REGISTERED DIETITIAN)
(208) 789-9664
Entity
Organization
Contact information
Practice address
894 E BOISE AVE, BOISE, ID 83706-5122
(208) 789-9664
Mailing address
894 E BOISE AVE, BOISE, ID 83706-5122
(208) 813-6015
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDTPID011885
—
ID
Enumeration date
03/07/2018
Last updated
12/16/2019
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