Provider Demographics
NPI:1801349113
Name:RICE, MINDY (RDN, LD)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E 5TH ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2977
Mailing Address - Country:US
Mailing Address - Phone:208-406-1961
Mailing Address - Fax:
Practice Address - Street 1:220 E 5TH ST
Practice Address - Street 2:SUITE 309
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2977
Practice Address - Country:US
Practice Address - Phone:208-406-1961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-453133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDD-453OtherIDAHO BOARD OF MEDICINE