Individual
KIMBERLY ANNE LANDSBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, LD
Contact information
Practice address
1488 N SUNUP WAY, EAGLE, ID 83616-7023
(208) 559-8319
Mailing address
1488 N SUNUP WAY, EAGLE, ID 83616-7023
(208) 559-8319
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
809925
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
809925
ACADEMY OF NUTRITION AND DIETETICS
VA
01
—
D-659
IDAHO BOARD OF MEDICINE
ID
Enumeration date
11/11/2019
Last updated
11/11/2019
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