Individual
HALEY WILLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD, ACSM-CEP
Contact information
Practice address
100 HOSPITAL DRIVE, KETHCUM, ID 83340
(208) 727-8356
Mailing address
PO BOX 640, BOISE, ID 83701-0640
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86057009
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86057009
CDR
ID
Enumeration date
03/31/2017
Last updated
03/31/2017
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