Anthony, Jennifer Lisa

Anthony, Jennifer Lisa is an individual health care provider with primary practice located at 777 N Raymond St , Boise ID 83704-9251. She recently has only one registered license in Dietary & Nutritional Service Providers / Nutrition, Pediatric, which is considered as her primary health care specialty. Anthony, Jennifer Lisa can be contacted via phone (208) 514-2500.

Contact Information

Primary practice address
777 N Raymond St Boise ID 83704-9251
Phone: (208) 514-2500
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Nutrition, Pediatric 133VN1004X

Profile Details

NPI number 1760156152
LBN Legal business name Anthony, Jennifer Lisa
Credentials Registered Dietitian (RD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 9th, 2021
Last updated Dec 15th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760156152 NPPES
Idaho MEDICAID 1760156152

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