Provider Demographics
NPI:1245707660
Name:I'MPOWERED NUTRITION & FITNESS, LLC
Entity type:Organization
Organization Name:I'MPOWERED NUTRITION & FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-358-3179
Mailing Address - Street 1:222 KENYON ST NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4578
Mailing Address - Country:US
Mailing Address - Phone:360-358-3179
Mailing Address - Fax:888-974-6419
Practice Address - Street 1:222 KENYON ST NW
Practice Address - Street 2:SUITE 1
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4578
Practice Address - Country:US
Practice Address - Phone:360-358-3179
Practice Address - Fax:888-974-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2074157Medicaid