Provider Demographics
NPI:1659665545
Name:BOQUETTE, LAURA MARGARET (RD, CSR, LD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARGARET
Last Name:BOQUETTE
Suffix:
Gender:F
Credentials:RD, CSR, LD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARGARET
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:5590 S ULEX PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-6925
Mailing Address - Country:US
Mailing Address - Phone:208-846-9815
Mailing Address - Fax:208-884-2032
Practice Address - Street 1:100 E IDAHO ST STE 200
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6270
Practice Address - Country:US
Practice Address - Phone:208-381-7081
Practice Address - Fax:208-381-6009
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-315133VN1005X, 133VN1006X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic