Organization
IDAHO STATE UNIVERSITY
Active
Other names
ISU Nutrition Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA LEE ROCK (CLINICS DIRECTOR OF OPERATIONS)
(208) 373-1743
Entity
Organization
Contact information
Practice address
1311 E CENTRAL DR, MERIDIAN, ID 83642-7991
(208) 373-1926
(833) 499-1813
Mailing address
1311 E CENTRAL DR, MERIDIAN, ID 83642-7991
(208) 373-1926
(833) 499-1813
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
133VN1005X
Renal Nutrition Registered Dietitian
—
—
133VN1006X
Metabolic Nutrition Registered Dietitian
—
—
133VN1101X
Gerontological Nutrition Registered Dietitian
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
133VN1301X
Oncology Nutrition Registered Dietitian
—
—
133VN1501X
Sports Dietetics Nutrition Registered Dietitian
—
—
Other
Enumeration date
01/26/2021
Last updated
01/26/2021
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