Provider Demographics
NPI:1225484587
Name:EVANS, RIKI (CNC)
Entity Type:Individual
Prefix:
First Name:RIKI
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 W BOULDER BAR DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5945
Mailing Address - Country:US
Mailing Address - Phone:208-794-8944
Mailing Address - Fax:
Practice Address - Street 1:2017 W BOULDER BAR DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5945
Practice Address - Country:US
Practice Address - Phone:208-475-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education