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General NPI Number Information
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NPI Number | 1487245122
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Entity Type | Organization
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Legal Business Name | IDAHO STATE UNIVERSITY
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 1311 E CENTRAL DR
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City | MERIDIAN
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State | ID
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Zip | 83642-7991
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Country | US
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Telephone | 208-373-1926
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Fax | 833-499-1813
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Provider Business Mailing Address
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Address Line | 1311 E CENTRAL DR
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City | MERIDIAN
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State | ID
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Zip | 83642-7991
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Country | US
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Telephone | 208-373-1926
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Fax | 833-499-1813
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Authorized Official
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Title or Position | CLINICS DIRECTOR OF OPERATIONS
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Name | CYNTHIA LEE ROCK
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Credential |
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Telephone | 208-373-1743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133VN1101X
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Taxonomy Name | Gerontological Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 133VN1301X
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Taxonomy Name | Oncology Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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