Individual
ALEXY VADA NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
680 E 5500 S, VICTOR, ID 83455-4613
(208) 270-4306
Mailing address
680 E 5500 S, VICTOR, ID 83455-4613
(208) 270-4306
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-1375
ID
Other
Enumeration date
08/29/2022
Last updated
08/29/2022
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