Marisue Smith, RD, CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D-767 Issued in ID

Practice address

1226 W River St
Boise, ID 83702-7049

Phone

(208) 331-1155

Fax

(208) 383-0190

NPI assigned

Jul 17, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458259200000",
    "number": "1710328836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1226 W RIVER ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027049",
            "telephone_number": "208-381-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1226 W RIVER ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027049",
            "telephone_number": "208-331-1155",
            "fax_number": "208-383-0190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARISUE",
        "credential": "RD, CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-17",
        "last_updated": "2016-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "D-767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710328836",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Abigail Smith
• Lauren Elise Smith, MS
• Lauren K Smith, FNP-BC
• Levi W Smith
• Lori J Smith, MD
• Mark Caldwell Smith, LPC - 9657
• Mathew Smith
• Melanie Smith
• Memry Smith, LPC, NCC
• Michael E Smith, DMD

• Registered Dietitian in Boise, ID
• Providers in Boise, ID by specialty
• Registered Dietitian in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.