NPI 1306436571 · live from the CMS NPI Registry
Colleen Anne Dibble, MS, RD
Dietitian, Registered in Boise, ID. National Provider Identifier 1306436571, active.
NPI record
| NPI | 1306436571 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 400 W Fort St, Boise, ID 83702 |
| Practice phone | 208-422-1000 |
| Mailing address | 1315 N 16th St, Boise, ID 83702 |
| Enumerated | January 21, 2021 |
| Last updated | January 21, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | D-464 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.