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General NPI Number Information
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NPI Number | 1063288892
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Entity Type | Individual
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Provider Name | SHALISSA MARIE TOMKINSON RD
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Gender | Female
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 725 POLE LINE RD W
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City | TWIN FALLS
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State | ID
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Zip | 83301-5800
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Country | US
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Telephone | 208-814-1600
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Fax | 208-814-1910
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D-1600
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License Number State | ID
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