Individual
MRS. MAXINE MYRA SCHROEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD, CDE
Contact information
Practice address
388 MARTIN ST, TWIN FALLS, ID 83301-4544
(208) 734-0451
(208) 734-0452
Mailing address
1360 E 3500 N, BUHL, ID 83316-6214
(208) 543-6579
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-219
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806421400
—
ID
Enumeration date
10/17/2007
Last updated
02/28/2008
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