Individual
BARBARA GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2723 N LAKEHARBOR LN, BOISE, ID 83703-6240
(208) 608-8082
Mailing address
2723 N LAKEHARBOR LN, BOISE, ID 83703-6240
(208) 608-8082
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-861
ID
Other
Enumeration date
05/21/2019
Last updated
05/21/2019
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