Healthcare Provider Details

I. General information

NPI: 1659665545
Provider Name (Legal Business Name): LAURA MARGARET BOQUETTE R.D., CSR, L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA MARGARET ANDERSON R.D., L.D.

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E IDAHO ST STE 200
BOISE ID
83712-6270
US

IV. Provider business mailing address

5590 S ULEX PL
BOISE ID
83716-6925
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-7081
  • Fax: 208-381-6009
Mailing address:
  • Phone: 208-846-9815
  • Fax: 208-884-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberD-315
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberD-315
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberD-315
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: