Individual
MARY ANN BROTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
500 WEST FORT, BOISE, ID 83702
(208) 422-1141
Mailing address
4443 MACKENZIE, BOISE, ID 83703
(208) 422-1141
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-092
ID
Other
Enumeration date
09/13/2006
Last updated
07/08/2007
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