Provider Demographics
NPI:1437779469
Name:NUTRITION DEJUNKED LLC
Entity Type:Organization
Organization Name:NUTRITION DEJUNKED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD
Authorized Official - Phone:208-629-2441
Mailing Address - Street 1:3350 W AMERICANA TER STE 215
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2545
Mailing Address - Country:US
Mailing Address - Phone:208-629-2441
Mailing Address - Fax:
Practice Address - Street 1:3350 W AMERICANA TER STE 215
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2545
Practice Address - Country:US
Practice Address - Phone:208-629-2441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-20
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty