Provider Demographics
NPI:1629424643
Name:NORTHWEST NUTRITION CONSULTATION
Entity Type:Organization
Organization Name:NORTHWEST NUTRITION CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUTY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:406-471-9998
Mailing Address - Street 1:140 CYCLONE DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7163
Mailing Address - Country:US
Mailing Address - Phone:406-471-9998
Mailing Address - Fax:
Practice Address - Street 1:140 CYCLONE DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-7163
Practice Address - Country:US
Practice Address - Phone:406-471-9998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT516261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty