Provider Demographics
NPI:1194552075
Name:RENOVATE YOUR LIFESTYLE
Entity type:Organization
Organization Name:RENOVATE YOUR LIFESTYLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH AND WELLNESS COACH
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:NBHWC
Authorized Official - Phone:435-268-2322
Mailing Address - Street 1:561 W 1360 N
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-1892
Mailing Address - Country:US
Mailing Address - Phone:702-335-1792
Mailing Address - Fax:
Practice Address - Street 1:561 W 1360 N
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-1892
Practice Address - Country:US
Practice Address - Phone:702-335-1792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty