Provider Demographics
NPI:1770920506
Name:SWATSENBARG, CHRISTINA ANN (RD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:SWATSENBARG
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 1:2225 TETON PLZ
Mailing Address - Street 2:SUITE #A
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6494
Mailing Address - Country:US
Mailing Address - Phone:208-522-4831
Mailing Address - Fax:208-552-5291
Practice Address - Street 1:2225 TETON PLZ
Practice Address - Street 2:SUITE #A
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6494
Practice Address - Country:US
Practice Address - Phone:208-522-4831
Practice Address - Fax:208-552-5291
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-374133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal