Individual
MARISUE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CDE
Contact information
Practice address
1226 W RIVER ST, BOISE, ID 83702-7049
(208) 331-1155
(208) 383-0190
Mailing address
1226 W RIVER ST, BOISE, ID 83702-7049
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-767
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710328836
—
ID
Enumeration date
07/17/2013
Last updated
03/18/2016
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