Individual
REBECCA T SULIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2220 E 25TH ST, IDAHO FALLS, ID 83404-7542
(208) 523-1122
(208) 523-2582
Mailing address
2220 E 25TH ST, IDAHO FALLS, ID 83404-7542
(208) 523-1122
(208) 523-2582
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
D257
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00126107
RAILROAD MEDICARE
ID
Enumeration date
07/09/2006
Last updated
07/08/2007
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