Individual
MARIAH ELISE STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
100 HOSPITAL DR., KETCHUM, ID 83340
(208) 727-8356
Mailing address
100 HOSPITAL DR., KETCHUM, ID 83340
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86097797
COMMISSION ON DIETETIC REGISTRATION
—
Enumeration date
07/18/2019
Last updated
07/18/2019
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