MEDICARE: NUTRITION SPECIALISTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	D043	ID

General Provider Information

NPI Number	:	1467680314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITION SPECIALISTS

Provider Business Mailing Address
First Line	:	2472 W LADLE RAPIDS ST
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-4771
Country	:	US
Telephone Number	:	208-343-3883
Fax Number	:	208-493-3087

Provider Business Practice Location Address
First Line	:	2472 W LADLE RAPIDS ST
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-4771
Country	:	US
Telephone Number	:	208-343-3883
Fax Number	:	208-493-3087

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JOLYN SEIBERT
Credential	:	RD
Telephone Number	:	208-343-3883

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	06/30/2009

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Directions to “NUTRITION SPECIALISTS ” Practice Location

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