Individual
JENNIFER COTTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
100 E IDAHO ST, BOISE, ID 83712-6267
(208) 381-8721
(208) 381-4025
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
86026446
WA
133V00000X
Registered Dietitian
Primary
D-1239
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336524040
—
WA
01
—
P01663048
RR PTAN WVH
WA
Enumeration date
07/23/2015
Last updated
11/02/2024
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