Provider Demographics
NPI:1457738478
Name:EWING, RACHEL (RD, LD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:EWING
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:ESTEP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:208-415-0299
Mailing Address - Fax:208-415-0299
Practice Address - Street 1:740 MCKINLEY AVE STE 100
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2693
Practice Address - Country:US
Practice Address - Phone:208-783-1267
Practice Address - Fax:877-807-3782
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
IDD-840133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered