Individual
JENNFIER L DICKISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RND
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-1316
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D-1316
STATE OF IDAHO
ID
Enumeration date
02/14/2023
Last updated
03/30/2023
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