Individual
HEIDI ROSE BRACKEBUSCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
PO BOX 642, OSBURN, ID 83849-0642
(208) 773-8111
Mailing address
PO BOX 642, OSBURN, ID 83849-0642
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
7671544
ID
Other
Enumeration date
12/02/2025
Last updated
12/02/2025
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