Provider Demographics
NPI:1144611872
Name:KUCHAR, JOBETH DEANNA (MS, RD, CSP, LD)
Entity Type:Individual
Prefix:
First Name:JOBETH
Middle Name:DEANNA
Last Name:KUCHAR
Suffix:
Gender:F
Credentials:MS, RD, CSP, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 DEER CREST STREET
Mailing Address - Street 2:BUILDING P #101
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1465 DEER CREST STREET
Practice Address - Street 2:BUILDING P 101
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:402-310-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-853133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric