Individual
MARY M BOSCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
3250 W CHERRY LANE, MERIDIAN, ID 83642
(208) 367-6127
(208) 367-7316
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-6127
(208) 367-7316
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
852745
CA
133V00000X
Registered Dietitian
Primary
D-751
ID
Other
Enumeration date
03/08/2012
Last updated
08/06/2013
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