Individual
KATIE MALISSA MIEDEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPH, RD
Contact information
Practice address
3000 E LUCCA DR, MERIDIAN, ID 83642-3083
(949) 572-9275
Mailing address
1740 E FAIRVIEW AVE # 99, MERIDIAN, ID 83642-5702
(949) 572-9275
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-1173
ID
Other
Enumeration date
02/10/2021
Last updated
02/10/2021
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