Provider Demographics
NPI:1376895672
Name:NALLE, SHEBA SUE (RD)
Entity Type:Individual
Prefix:
First Name:SHEBA
Middle Name:SUE
Last Name:NALLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1973 WHITE AVE APT 406
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3981
Mailing Address - Country:US
Mailing Address - Phone:208-596-9876
Mailing Address - Fax:
Practice Address - Street 1:1973 WHITE AVE APT 406
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3981
Practice Address - Country:US
Practice Address - Phone:208-596-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered