Provider Demographics
NPI:1568252856
Name:POSITIVELY NOURISHED LLC
Entity type:Organization
Organization Name:POSITIVELY NOURISHED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:208-607-5864
Mailing Address - Street 1:1153 TERRA AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4734
Mailing Address - Country:US
Mailing Address - Phone:208-607-5864
Mailing Address - Fax:
Practice Address - Street 1:1153 TERRA AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4734
Practice Address - Country:US
Practice Address - Phone:208-607-5864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1528778933OtherINDIVIDUAL NPI FOR STEPHANIE PUGH, OWNER