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General NPI Number Information
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NPI Number | 1700862976
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Entity Type | Individual
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Provider Name | TINA K MCGREW MS, RD, LD
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Gender | Female
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 1581 RED FEATHER WAY
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City | HAILEY
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State | ID
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Zip | 83333-8957
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Country | US
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Telephone | 208-928-4152
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Fax |
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Provider Business Mailing Address
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Address Line | 1581 RED FEATHER WAY
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City | HAILEY
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State | ID
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Zip | 83333-8957
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Country | US
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Telephone | 208-309-8748
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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 | LD-D-10237123
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 178
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 5754
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 9434803-4091
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License Number State | UT
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Taxonomy #5
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164.009935
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D-918
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License Number State | ID
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