Provider Demographics
NPI:1275177560
Name:TRAVELING MAMA ENTERPRISES, LLC
Entity type:Organization
Organization Name:TRAVELING MAMA ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, CLC, RDN
Authorized Official - Phone:406-209-3995
Mailing Address - Street 1:67 S LEWIS AND CLARK TRL
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MT
Mailing Address - Zip Code:59759-9547
Mailing Address - Country:US
Mailing Address - Phone:406-209-3995
Mailing Address - Fax:406-451-0551
Practice Address - Street 1:67 S LEWIS AND CLARK TRL
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MT
Practice Address - Zip Code:59759-9547
Practice Address - Country:US
Practice Address - Phone:406-209-3995
Practice Address - Fax:406-451-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMED-NUTR-LIC-408OtherSTATE LICENSE