Organization
BOISE OPTIMAL NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEDINA E BLANCHET RDN (MANAGING MEMBER/PROVIDER)
(425) 220-9972
Entity
Organization
Contact information
Practice address
6126 W STATE ST STE 206, BOISE, ID 83703-2741
(208) 391-3353
(208) 501-8922
Mailing address
12747 N 11TH AVE, BOISE, ID 83714-9334
(425) 220-9972
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
02/12/2019
Last updated
09/07/2023
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