Provider Demographics
NPI:1104690734
Name:NOURISHED IQ NUTRITION STUDIO LLC
Entity type:Organization
Organization Name:NOURISHED IQ NUTRITION STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIROSTKO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:406-384-7290
Mailing Address - Street 1:5570 SAPPHIRE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6657
Mailing Address - Country:US
Mailing Address - Phone:406-384-7290
Mailing Address - Fax:
Practice Address - Street 1:5570 SAPPHIRE RIDGE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6657
Practice Address - Country:US
Practice Address - Phone:406-384-7290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty