NPI 1992428809 · live from the CMS NPI Registry
Jordan Camille Dansereau, RDN, IBCLC
Dietitian, Registered in Hayden, ID. National Provider Identifier 1992428809, active.
NPI record
| NPI | 1992428809 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 8500 N Atlas Rd, Hayden, ID 83835 |
| Practice phone | 208-415-5284 |
| Enumerated | September 26, 2022 |
| Last updated | June 24, 2025 |
| Sole proprietor | Yes |
| Other names | Jordan Pratt |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Lactation Consultant, Non-RN | 174N00000X | L-316372 |
| Dietitian, Registered primary | 133V00000X | 86210366 |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.