NPI 1477415982 · live from the CMS NPI Registry
Heidi Rose Brackebusch, RDN
Dietitian, Registered in Coeur D Alene, ID. National Provider Identifier 1477415982, active.
NPI record
| NPI | 1477415982 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 1765 W Golf Course Rd, Coeur D Alene, ID 83815 |
| Practice phone | 208-277-0795 |
| Mailing address | 1917 N Lakewood Dr, Coeur D Alene, ID 83814 |
| Enumerated | December 2, 2025 |
| Last updated | May 13, 2026 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 7671544 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.