| Organization Name: | WELLNESS IMPACT NUTRITION, LLC |
| NPI Number: | 1649660549 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEENA M LAJOIE (OWNER/REGISTERED DIETITIAN) |
| Mailing Address: | 1013 E Winding Creek Dr Suite 102 Eagle |
| State: | ID US |
| Postal Code: | 836167060 |
| Phone Number: | 2082505657 |
| Fax Number: | 2084339424 |
| NPI Enumeration Date: | 01/29/2015 |
| NPI Last Update Date: | 02/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | D-682 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |