Provider Demographics
NPI:1417061144
Name:RETTMANN, BOBBI JO MILLER (MS, RD, CD)
Entity Type:Individual
Prefix:MRS
First Name:BOBBI JO
Middle Name:MILLER
Last Name:RETTMANN
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 L CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5287
Mailing Address - Country:US
Mailing Address - Phone:509-954-3387
Mailing Address - Fax:
Practice Address - Street 1:8906 L CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5287
Practice Address - Country:US
Practice Address - Phone:509-343-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001643133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7601339Medicaid
WA7601339Medicaid