MEDICARE: RIKI EVANS CNC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist
2	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1225484587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIKI EVANS CNC

Provider Business Mailing Address
First Line	:	2017 W BOULDER BAR DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5945
Country	:	US
Telephone Number	:	208-794-8944
Fax Number	:

Provider Business Practice Location Address
First Line	:	2017 W BOULDER BAR DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5945
Country	:	US
Telephone Number	:	208-475-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2016
Last Update Date	:	05/05/2016

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Directions to “ RIKI EVANS CNC” Practice Location

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