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Organization
IDAHO STATE UNIVERSITY
Active
Organization
IDAHO STATE UNIVERSITY
Active
Other names
ISU Nutrition Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA LEE ROCK (CLINICS DIRECTOR OF OPERATIONS)
(208) 373-1743
Entity
Organization
Contact information
Practice address
1311 E CENTRAL DR, MERIDIAN, ID 83642-7991
(208) 373-1926
(833) 499-1813
Mailing address
1311 E CENTRAL DR, MERIDIAN, ID 83642-7991
(208) 373-1926
(833) 499-1813
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
NULL
133N00000X
Nutritionist
—
—
133NN1002X
Nutrition Education Nutritionist
Primary
—
NULL
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
133VN1005X
Renal Nutrition Registered Dietitian
—
NULL
133VN1005X
Renal Nutrition Registered Dietitian
—
—
133VN1006X
Metabolic Nutrition Registered Dietitian
—
NULL
133VN1006X
Metabolic Nutrition Registered Dietitian
—
—
133VN1101X
Gerontological Nutrition Registered Dietitian
—
NULL
133VN1101X
Gerontological Nutrition Registered Dietitian
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
NULL
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
133VN1301X
Oncology Nutrition Registered Dietitian
—
NULL
133VN1301X
Oncology Nutrition Registered Dietitian
—
—
133VN1501X
Sports Dietetics Nutrition Registered Dietitian
—
NULL
133VN1501X
Sports Dietetics Nutrition Registered Dietitian
—
—
Other
Enumeration date
01/26/2021
Last updated
01/26/2021
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