Individual
CHANEL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN, LD
Contact information
Practice address
2278 MORITZ LN, INDIAN VALLEY, ID 83632-5019
(208) 816-8365
Mailing address
2278 MORITZ LN, INDIAN VALLEY, ID 83632-5019
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-859
ID
Other
Enumeration date
08/28/2019
Last updated
08/28/2019
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