MEDICARE: AMBER BULCHER RDN, LD

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	133V00000X	Registered Dietitian	D-772	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86006692	OTHER		COMMISSION OF DIETETIC REGISTRATION

General Provider Information

NPI Number	:	1306475314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER BULCHER RDN, LD

Provider Business Mailing Address
First Line	:	1010 S PHILLIPPI ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83705-1947
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2867 E COPPER POINT DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-1716
Country	:	US
Telephone Number	:	208-401-9100
Fax Number	:

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

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	04/02/2020

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