Provider Demographics
NPI:1255408951
Name:EAT WELL NUTRITION THERAPY, LLC
Entity type:Organization
Organization Name:EAT WELL NUTRITION THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:KAUPA
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LN
Authorized Official - Phone:507-390-0229
Mailing Address - Street 1:PO BOX 913
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-0913
Mailing Address - Country:US
Mailing Address - Phone:507-390-0229
Mailing Address - Fax:507-451-3322
Practice Address - Street 1:202 1/2 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2392
Practice Address - Country:US
Practice Address - Phone:507-390-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNN122133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN118175OtherHEALTHPARTNERS
MN63-50011OtherMEDICA
MN136634OtherUCARE
MN342G5EAOtherBLUE CROSS BLUE SHIELD
MN=========OtherMMSI
MN136634OtherUCARE