Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Nutrition, Education |
133NN1002X | |||
Nutrition, Gerontological |
133VN1101X | 71 | Registered Dietitian or Nutrition Professional | |
Nutrition, Metabolic |
133VN1006X | 71 | Registered Dietitian or Nutrition Professional | |
Nutrition, Obesity and Weight Management |
133VN1201X | 71 | Registered Dietitian or Nutrition Professional | |
Nutrition, Oncology |
133VN1301X | 71 | Registered Dietitian or Nutrition Professional | |
Nutrition, Renal |
133VN1005X | 71 | Registered Dietitian or Nutrition Professional | |
Nutrition, Sports Dietetics |
133VN1501X | 71 | Registered Dietitian or Nutrition Professional | |
Nutritionist |
133N00000X |
| NPI Number | 1487245122 |
| LBN Legal business name | IDAHO STATE UNIVERSITY |
| Authorized official | CYNTHIA ROCK - (CLINICS DIRECTOR OF OPERATIONS) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 01/26/2021 |
| Last updated | 01/26/2021 - About 5 years ago |
| Identifiers | n/a |
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IDAHO STATE UNIVERSITY
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| JOBETH D KUCHAR, MS, RD, CSP, LD 1465 DEER CREST STREET MERIDIAN, ID |
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