Provider Demographics
NPI:1306211354
Name:NOURISH, LLC
Entity Type:Organization
Organization Name:NOURISH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:URNESS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LN
Authorized Official - Phone:406-580-7307
Mailing Address - Street 1:2100 FAIRWAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5814
Mailing Address - Country:US
Mailing Address - Phone:406-580-7307
Mailing Address - Fax:
Practice Address - Street 1:2100 FAIRWAY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5814
Practice Address - Country:US
Practice Address - Phone:406-580-7307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-NUTR-LIC-43156133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty