Provider Demographics
NPI:1972491280
Name:LIVE WELL DIETITIAN LLC
Entity type:Organization
Organization Name:LIVE WELL DIETITIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-326-5999
Mailing Address - Street 1:7112 CHAPELLE AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-1008
Mailing Address - Country:US
Mailing Address - Phone:208-932-6599
Mailing Address - Fax:
Practice Address - Street 1:7112 CHAPELLE AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-1008
Practice Address - Country:US
Practice Address - Phone:208-932-6599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty