NPI 1609424183 · live from the CMS NPI Registry
Chanel Clark, RDN, LD
Dietitian, Registered in Indian Valley, ID. National Provider Identifier 1609424183, active.
NPI record
| NPI | 1609424183 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 2278 Moritz Ln, Indian Valley, ID 83632 |
| Practice phone | 208-816-8365 |
| Enumerated | August 28, 2019 |
| Last updated | August 28, 2019 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | D-859 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.