Basic Information
| Provider Information | |||||||||
| NPI: | 1215406830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IHNEN | ||||||||
| FirstName: | BRADY | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7335 SHADOW LAKE PLZ APT 215 | ||||||||
| Address2: | |||||||||
| City: | PAPILLION | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680464865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057598127 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 W BROADWAY STE 150 | ||||||||
| Address2: | |||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515039077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123880261 | ||||||||
| FaxNumber: | 7123880269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2018 | ||||||||
| LastUpdateDate: | 11/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 1283 | NE | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 090097 | IA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.