Provider Demographics
NPI:1174194757
Name:WILDHEART NUTRITION THERAPY
Entity Type:Organization
Organization Name:WILDHEART NUTRITION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDN
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-318-7746
Mailing Address - Street 1:5305 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98407-3215
Mailing Address - Country:US
Mailing Address - Phone:501-318-7746
Mailing Address - Fax:
Practice Address - Street 1:2711 N 21ST ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-7519
Practice Address - Country:US
Practice Address - Phone:501-318-7746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty