Doctor Name: | L. ELAINE NIEBAUR |
NPI Number: | 1023240496 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD,CSR, LD |
License Number: | D-009 |
Business Practice Address: | 1522 Sod Farm Rd Pocatello, ID - 832047532 |
Business Phone Number: | 2086371094 |
Business Fax Number: | 2086370750 |
Mailing Address: | 1522 Sod Farm Rd, POCATELLO |
State: | ID |
Postal Code: | 832047532 |
Phone Number: | 2086371094 |
Fax Number: | 2086370750 |
NPI Enumeration Date: | 08/18/2009 |
NPI Last Update Date: | 08/18/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133VN1005X |
License Number: | D-009 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | Nutrition, Renal |
Taxonomy Definition: |