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NPI Code Detail

MEDICARE: NANCI GRAYSON JENKINS M.S., RDN, LD

MEDICARE: NANCI GRAYSON JENKINS M.S., 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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1912460387
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCI GRAYSON JENKINS M.S., RDN, LD
Provider Business Mailing Address
First Line : 8500 N. ATLAS RD
Second Line :
City : HAYDEN
State : ID
Zip : 83835-8332
Country : US
Telephone Number : 208-415-5100
Fax Number : 208-415-5101
Provider Business Practice Location Address
First Line : 8500 N. ATLAS RD
Second Line :
City : HAYDEN
State : ID
Zip : 83835-8332
Country : US
Telephone Number : 208-415-5100
Fax Number : 208-415-5101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2019
Last Update Date : 04/11/2019

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