Provider Demographics
NPI:1972616001
Name:SCHWARTZ, VIRGINIA MB (RD)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:MB
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:M
Other - Last Name:BOES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:7869 W HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-7619
Mailing Address - Country:US
Mailing Address - Phone:208-664-4353
Mailing Address - Fax:
Practice Address - Street 1:4815 N ASSEMBLY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6185
Practice Address - Country:US
Practice Address - Phone:509-434-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID714506133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered