Provider Demographics
NPI:1548848351
Name:FREIRE, ANNALISA (RDN)
Entity type:Individual
Prefix:
First Name:ANNALISA
Middle Name:
Last Name:FREIRE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3393 MERLIN DR STE A
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7490
Mailing Address - Country:US
Mailing Address - Phone:208-643-5343
Mailing Address - Fax:
Practice Address - Street 1:3393 MERLIN DR STE A
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7490
Practice Address - Country:US
Practice Address - Phone:208-643-5343
Practice Address - Fax:405-259-0767
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86118497133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered