Active NPI
Chanel Drucker
- Registered Dietitian
- Meridian, ID
National Provider Identifier
1558035816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- D-1288
- Practice address
- 2960 E. St. Luke'S Street Suite 200
Meridian, ID 83642-9005 - Phone
- (208) 378-4264
- NPI assigned
- Aug 2, 2021
- Reactivated
- Oct 18, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | D-1288 | ID | Primary |
Addresses
Primary practice location
2960 E. St. Luke'S Street Suite 200
Meridian, ID 83642-9005
Mailing address
2960 E. St. Luke'S Street Suite 200
Meridian, ID 83642-9099
Phone (208) 378-4264
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-1288 | ID | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635984000000",
"number": "1558035816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2960 E. ST. LUKE'S STREET SUITE 200",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836429099",
"telephone_number": "208-378-4264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2960 E. ST. LUKE'S STREET SUITE 200",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836429005",
"telephone_number": "208-378-4264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRUCKER",
"first_name": "CHANEL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-02",
"last_updated": "2021-11-04",
"certification_date": "2021-10-18",
"deactivation_date": "2021-09-29",
"reactivation_date": "2021-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "D-1288",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.