Provider Demographics
NPI:1023673555
Name:MEGHAN WOMACK NUTRITION LLC
Entity type:Organization
Organization Name:MEGHAN WOMACK NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:406-219-8462
Mailing Address - Street 1:3354 WARBLER WAY UNIT B
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7747
Mailing Address - Country:US
Mailing Address - Phone:505-793-2826
Mailing Address - Fax:
Practice Address - Street 1:1940 W DICKERSON ST STE 207
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6851
Practice Address - Country:US
Practice Address - Phone:406-219-8462
Practice Address - Fax:406-551-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty