Individual
MACEY RENAE LEATHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
1298 IDAHO AVE APT 1, IDAHO FALLS, ID 83402-1247
(208) 716-0244
Mailing address
1298 IDAHO AVE APT 1, IDAHO FALLS, ID 83402-1247
(208) 716-0244
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86096533
ID
Other
Enumeration date
02/02/2021
Last updated
02/02/2021
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