WHOLE BODY NUTRITION AND FITNESS
Complete NPI Record 1700583739
Dietitian, Registered in Boise, ID

NPI Status: Active since February 09, 2023

Contact Information

2518 N LANCASTER DR
BOISE, ID
ZIP 83702
Phone: (208) 991-2066
Fax: (888) 412-1479

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Complete NPI Dataset

The following table represents the complete dataset for NPI number 1700583739. The table includes a list of all field names, values and definitions of the full NPI record. This dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.

Name Value Definition
NPI1700583739The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameWHOLE BODY NUTRITION AND FITNESSThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address2518 N LANCASTER DRThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameBOISEThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameIDThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code837020635The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number2089912066The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number8884121479The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address2518 N LANCASTER DRThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameBOISEThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIDThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code837020635The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number2089912066The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number8884121479The fax number associated with the location address of the provider being identified.
Provider Enumeration Date2/9/2023The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date10/2/2023The date that a record was last updated or changed.
Authorized Official Last NameBAILEYThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameANDREAThe first name of the authorized official.
Authorized Official Middle NameLThe middle name of the authorized official.
Authorized Official Title or PositionOWNER, REGISTERED DIETITIANThe title or position of the authorized official.
Authorized Official Telephone Number2089912066The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1133V00000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1Y
Is Organization SubpartN
Authorized Official Credential TextRD
Healthcare Provider Taxonomy Group 1193400000X SINGLE SPECIALTY GROUP
NPI Certification Date10/2/2023