NPI 1376470153 · live from the CMS NPI Registry
Country Roots Nutrition LLC
Dietitian, Registered in Cheyenne, WY. National Provider Identifier 1376470153, active.
NPI record
| NPI | 1376470153 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 312 E Carlson St, Cheyenne, WY 82009 |
| Practice phone | 307-509-0641 |
| Enumerated | May 6, 2026 |
| Last updated | May 6, 2026 |
| Authorized official | Sally Printz, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.