Provider Demographics
NPI:1053570515
Name:TOMCHAK, LUANA (RD)
Entity type:Individual
Prefix:
First Name:LUANA
Middle Name:
Last Name:TOMCHAK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6429
Mailing Address - Country:US
Mailing Address - Phone:208-529-2352
Mailing Address - Fax:208-528-3332
Practice Address - Street 1:1957 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6429
Practice Address - Country:US
Practice Address - Phone:208-529-2352
Practice Address - Fax:208-528-3332
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-106133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered