Healthcare Provider Details

I. General information

NPI: 1457738478
Provider Name (Legal Business Name): RACHEL EWING RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL ESTEP RD, LD

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 MCKINLEY AVE STE 100
KELLOGG ID
83837-2693
US

IV. Provider business mailing address

PO BOX 1387
HAYDEN ID
83835-1387
US

V. Phone/Fax

Practice location:
  • Phone: 208-783-1267
  • Fax: 877-807-3782
Mailing address:
  • Phone: 208-415-0299
  • Fax: 208-415-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-840
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: