Individual
MEDINA E BLANCHET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
13900 W WAINWRIGHT DR STE 103, BOISE, ID 83713-5028
(208) 433-9424
(844) 833-5686
Mailing address
12747 N 11TH AVE, BOISE, ID 83714-9334
(208) 391-3353
(208) 229-7014
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-741
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D-741
DIETITIAN LICENSE
ID
Enumeration date
05/05/2011
Last updated
09/07/2023
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