Provider Demographics
NPI:1316914054
Name:MCDOWELL, MARNI MAY (MS, RD)
Entity type:Individual
Prefix:MS
First Name:MARNI
Middle Name:MAY
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 S FEDERAL WAY # MS 1-706
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-9632
Mailing Address - Country:US
Mailing Address - Phone:208-908-1317
Mailing Address - Fax:208-368-5607
Practice Address - Street 1:8000 S FEDERAL WAY # MS 1-706
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-9632
Practice Address - Country:US
Practice Address - Phone:208-908-1317
Practice Address - Fax:208-368-5607
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-550133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000003665Medicare ID - Type Unspecified