Provider Demographics
NPI:1629628060
Name:DYE, JOSEPHINE ELAINE (RD)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ELAINE
Last Name:DYE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:ELAINE
Other - Last Name:COBIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4479 OLEARY RD
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2858
Mailing Address - Country:US
Mailing Address - Phone:208-240-0814
Mailing Address - Fax:
Practice Address - Street 1:4479 OLEARY RD
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2858
Practice Address - Country:US
Practice Address - Phone:208-240-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1140133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered