Individual
HEIDI ROSE BRACKEBUSCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
1765 W GOLF COURSE RD, COEUR D ALENE, ID 83815-9033
(208) 277-0795
Mailing address
1917 N LAKEWOOD DR, COEUR D ALENE, ID 83814-2634
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
7671544
ID
Other
Enumeration date
12/02/2025
Last updated
05/13/2026
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