Provider Demographics
NPI:1740766542
Name:BELL, LESLIE MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:MARIE
Last Name:BELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3986 N 3540 E
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341-5147
Mailing Address - Country:US
Mailing Address - Phone:208-420-9777
Mailing Address - Fax:
Practice Address - Street 1:3986 N 3540 E
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-5147
Practice Address - Country:US
Practice Address - Phone:208-420-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-14
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-457133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered