Provider Demographics
NPI:1033243019
Name:O'BRIEN, RHONDA L (MS, RD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5023
Mailing Address - Country:US
Mailing Address - Phone:208-342-2228
Mailing Address - Fax:208-343-0889
Practice Address - Street 1:1414 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5023
Practice Address - Country:US
Practice Address - Phone:208-342-2228
Practice Address - Fax:208-343-0889
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2014-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-218133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered