Provider Demographics
NPI:1508507344
Name:BUILD STRONG NUTRITION, LLC
Entity Type:Organization
Organization Name:BUILD STRONG NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:CALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, RDN, LD, CPT
Authorized Official - Phone:208-871-8755
Mailing Address - Street 1:1200 HOLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2907
Mailing Address - Country:US
Mailing Address - Phone:208-871-8755
Mailing Address - Fax:888-462-8913
Practice Address - Street 1:1200 HOLMAN AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2907
Practice Address - Country:US
Practice Address - Phone:208-871-8755
Practice Address - Fax:888-462-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center