Provider Demographics
NPI:1164030755
Name:SANDY KIPP RDN LLC
Entity Type:Organization
Organization Name:SANDY KIPP RDN LLC
Other - Org Name:'IN CARE OF' NOURISH YOUR LIFE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIPP
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:208-250-0836
Mailing Address - Street 1:823 W MOUNTAIN ASH LOOP
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2681
Mailing Address - Country:US
Mailing Address - Phone:208-250-0836
Mailing Address - Fax:888-972-6280
Practice Address - Street 1:1105 2ND ST. S.
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651
Practice Address - Country:US
Practice Address - Phone:208-250-0836
Practice Address - Fax:888-972-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty