Jordan Camille Dansereau, RDN, IBCLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86210366

Practice address

8500 N Atlas Rd
Hayden, ID 83835-8332

Phone

(208) 415-5284

NPI assigned

Sep 26, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jordan Camille Pratt Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1992428809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8500 N ATLAS RD",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838358332",
            "telephone_number": "208-415-5284",
            "fax_number": "208-415-5131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8500 N ATLAS RD",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838358332",
            "telephone_number": "208-415-5284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANSEREAU",
        "first_name": "JORDAN",
        "middle_name": "CAMILLE",
        "credential": "RDN, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-26",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": null,
            "license": "L-316372",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": "86210366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDAN",
            "last_name": "PRATT",
            "middle_name": "CAMILLE",
            "credential": "RDN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Hayden, ID
• Registered Dietitian in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.