Individual
MARY MONROE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN, LD, IBCLC
Contact information
Practice address
8500 N ATLAS RD, HAYDEN, ID 83835-8332
(208) 415-5136
(208) 415-5131
Mailing address
8500 N ATLAS RD, HAYDEN, ID 83835-8332
(208) 415-5136
(208) 415-5131
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-363
ID
174N00000X
Lactation Consultant (Non-RN)
L-304099
—
Other
Enumeration date
05/21/2025
Last updated
06/18/2025
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