NPI 1740605740 · live from the CMS NPI Registry
Joanna Bork
Dietitian, Registered, Nutrition, Pediatric in Boise, ID. National Provider Identifier 1740605740, active.
NPI record
| NPI | 1740605740 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered, Nutrition, Pediatric 133VN1004X |
| Practice location | 100 E Idaho St, Suite 200, Boise, ID 83712 |
| Practice phone | 208-381-7081 |
| Mailing address | 624 N Glen Aspen Way, Star, ID 83669 |
| Enumerated | February 27, 2014 |
| Last updated | February 27, 2014 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered, Nutrition, Pediatric primary | 133VN1004X | D-288 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.