Healthcare Provider Details

I. General information

NPI: 1245062447
Provider Name (Legal Business Name): SUMMIT NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 N MINAM LOOP
POST FALLS ID
83854-1601
US

IV. Provider business mailing address

1733 N MINAM LOOP
POST FALLS ID
83854-1601
US

V. Phone/Fax

Practice location:
  • Phone: 208-691-3488
  • Fax:
Mailing address:
  • Phone: 208-425-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ECHO HEIMAN
Title or Position: OWNER
Credential: RD, CSR, LD, CD
Phone: 208-425-1882