Provider Demographics
NPI:1164671699
Name:WILLIAMS, MEGAN RICHARDSON (RD, LD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RICHARDSON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:SHOSHONE
Mailing Address - State:ID
Mailing Address - Zip Code:83352-0609
Mailing Address - Country:US
Mailing Address - Phone:208-964-4684
Mailing Address - Fax:
Practice Address - Street 1:113 S APPLE ST
Practice Address - Street 2:
Practice Address - City:SHOSHONE
Practice Address - State:ID
Practice Address - Zip Code:83352-5287
Practice Address - Country:US
Practice Address - Phone:208-886-2224
Practice Address - Fax:208-886-2634
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-499133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered