Individual
TENNILLE IRENE HOUSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHE, RD, LD, CDE
Contact information
Practice address
1501 HILAND AVE, CASSIA REGIONAL MEDICAL CENTER, BURLEY, ID 83318-2682
(208) 677-6587
Mailing address
278 DOLLAR HIDE WAY, JEROME, ID 83338-6554
(208) 731-8789
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-348
ID
Other
Enumeration date
10/17/2006
Last updated
07/08/2007
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