| NPI | 1124569959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN PAIGE MCCOY Owner Registered Dietitian 208-866-2568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 133VN1004X Dietitian, Registered, Nutrition, Pediatric |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2017-03-13 |