Ilse M Moreno, RDN | |
305 E Jefferson St, Boise, ID 83712-6231 | |
(208) 381-7081 | |
Not Available |
Full Name | Ilse M Moreno |
---|---|
Gender | Female |
Speciality | Dietitian, Registered |
Location | 305 E Jefferson St, Boise, Idaho |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1477229250 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | (* (Not Available)) | Secondary |
133V00000X | Dietitian, Registered | D-1272 (Idaho) | Primary |
Provider Name | Lourdes Hospital Llc |
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Provider Type | Part A Provider - Critical Access Hospital |
Provider Identifiers | NPI Number: 1831284280 PECOS PAC ID: 1850642562 Enrollment ID: O20180919002474 |
Provider Name | Lourdes Hospital Llc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1659861060 PECOS PAC ID: 1850642562 Enrollment ID: O20181113000853 |
Mailing Address | Practice Location Address |
---|---|
Ilse M Moreno, RDN 190 E Bannock St, Boise, ID 83712-6241 Ph: () - | Ilse M Moreno, RDN 305 E Jefferson St, Boise, ID 83712-6231 Ph: (208) 381-7081 |
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