Active NPI
L. Elaine Niebaur, RD,CSR, LD
- Renal Nutrition Registered Dietitian
- Pocatello, ID
National Provider Identifier
1023240496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Renal Nutrition Registered Dietitian
- License
- D-009
- Practice address
- 1522 Sod Farm Rd
Pocatello, ID 83204-7532 - Phone
- (208) 637-1094
- Fax
- (208) 637-0750
- NPI assigned
- Aug 18, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Renal Nutrition Registered Dietitian | 133VN1005X | D-009 | ID | Primary |
Addresses
Primary practice location
1522 Sod Farm Rd
Pocatello, ID 83204-7532
Mailing address
1522 Sod Farm Rd
Pocatello, ID 83204-7532
Phone (208) 637-1094
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-009 | ID | MD | Renal Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1250553600000",
"number": "1023240496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1522 SOD FARM RD",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832047532",
"telephone_number": "208-637-1094",
"fax_number": "208-637-0750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1522 SOD FARM RD",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832047532",
"telephone_number": "208-637-1094",
"fax_number": "208-637-0750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIEBAUR",
"first_name": "L.",
"middle_name": "ELAINE",
"credential": "RD,CSR, LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-18",
"last_updated": "2009-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1005X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Renal",
"state": "ID",
"license": "D-009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.