| NPI | 1053805382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LEE CLARK Corporation Owner 307-683-6874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: WY 232) |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education |
| 133VN1004X Dietitian, Registered, Nutrition, Pediatric | |
| 133VN1006X Dietitian, Registered, Nutrition, Metabolic | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2018-06-20 |