Provider Demographics
NPI:1417713108
Name:INTEGRATIVE FUNCTIONAL NUTRITION
Entity Type:Organization
Organization Name:INTEGRATIVE FUNCTIONAL NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINCIAL NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:MELANEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, CD, LDN
Authorized Official - Phone:801-471-3120
Mailing Address - Street 1:563 W 500 S STE 440
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8296
Mailing Address - Country:US
Mailing Address - Phone:501-471-3120
Mailing Address - Fax:138-544-0901
Practice Address - Street 1:563 W 500 S STE 440
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8296
Practice Address - Country:US
Practice Address - Phone:501-471-3120
Practice Address - Fax:138-544-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty