Active NPI
Maryanne Hartman Cunningham, RDN
- Registered Dietitian
- Eagle, ID
National Provider Identifier
1578024345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- D-802
- Practice address
- 735 W Watersford Dr
Eagle, ID 83616-7150 - Phone
- (208) 867-1763
- NPI assigned
- Mar 26, 2019
- 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 | D-802 | ID | Primary |
Addresses
Primary practice location
735 W Watersford Dr
Eagle, ID 83616-7150
Mailing address
735 W Watersford Dr
Eagle, ID 83616-7150
Phone (208) 867-1763
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-802 | ID | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Idaho Nutrition Associates, LLC | Dietitian, Registered | Current | Accepting new patients |
Locations
13900 W Wainwright Dr
Ste 102
Boise, ID 83713
Phone (208) 433-9424
1013 E Winding Creek Dr
Ste 102
Eagle, ID 83616
Phone (208) 250-5657
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553558400000",
"number": "1578024345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "735 W WATERSFORD DR",
"city": "EAGLE",
"state": "ID",
"postal_code": "836167150",
"telephone_number": "208-867-1763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "735 W WATERSFORD DR",
"city": "EAGLE",
"state": "ID",
"postal_code": "836167150",
"telephone_number": "208-867-1763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUNNINGHAM",
"first_name": "MARYANNE",
"middle_name": "HARTMAN",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-03-26",
"last_updated": "2019-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "D-802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.