Active NPI
Marissa Rudley, RD
- Registered Dietitian
- Moscow, ID
National Provider Identifier
1184120255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI60841342
- Practice address
- 417 Gambels LN
Moscow, ID 83843-8213 - Phone
- (208) 340-2023
- NPI assigned
- Apr 5, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DI60841342 | WA | Primary |
Addresses
Primary practice location
417 Gambels LN
Moscow, ID 83843-8213
Mailing address
417 Gambels LN
Moscow, ID 83843-8213
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI60841342 | WA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737504000000",
"number": "1184120255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "417 GAMBELS LN",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838438213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "417 GAMBELS LN",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838438213",
"telephone_number": "208-340-2023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDLEY",
"first_name": "MARISSA",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-05",
"last_updated": "2025-01-22",
"certification_date": "2025-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "DI60841342",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moscow, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.