Provider Demographics
NPI:1558664755
Name:RICH, MARJORIE CONRAD (MS, RD, LD, CDE)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:CONRAD
Last Name:RICH
Suffix:
Gender:F
Credentials:MS, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 N ESQUIRE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-6210
Mailing Address - Country:US
Mailing Address - Phone:208-377-5881
Mailing Address - Fax:
Practice Address - Street 1:707 N ARMSTRONG PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-0825
Practice Address - Country:US
Practice Address - Phone:208-861-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-038133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic