Individual
MS. LAURA JEAN MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.N.
Contact information
Practice address
285 E 4TH N, MOUNTAIN HOME, ID 83647-2716
(208) 590-0858
(855) 740-2997
Mailing address
PO BOX 425, MOUNTAIN HOME, ID 83647-0425
(208) 590-0858
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-039
ID
Other
Enumeration date
02/13/2018
Last updated
02/13/2018
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