Provider Demographics
NPI:1467680314
Name:NUTRITION SPECIALISTS
Entity Type:Organization
Organization Name:NUTRITION SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:208-343-3883
Mailing Address - Street 1:2472 W LADLE RAPIDS ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4771
Mailing Address - Country:US
Mailing Address - Phone:208-343-3883
Mailing Address - Fax:208-493-3087
Practice Address - Street 1:2472 W LADLE RAPIDS ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-4771
Practice Address - Country:US
Practice Address - Phone:208-343-3883
Practice Address - Fax:208-493-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD043133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty