Individual
STACI M KIDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
5418 N EAGLE RD STE 120, BOISE, ID 83713-0103
(208) 939-1500
(208) 939-1510
Mailing address
5418 N EAGLE RD STE 120, BOISE, ID 83713-0103
(208) 939-1500
(208) 939-1510
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-468
ID
Other
Enumeration date
03/13/2013
Last updated
03/13/2013
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