Provider Demographics
NPI:1255218624
Name:MOQUETTE-MAGEE, ELAINE (RD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:MOQUETTE-MAGEE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E PARKCENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3999
Mailing Address - Country:US
Mailing Address - Phone:650-681-7816
Mailing Address - Fax:623-869-1840
Practice Address - Street 1:250 E PARKCENTER BLVD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3999
Practice Address - Country:US
Practice Address - Phone:650-681-7816
Practice Address - Fax:623-869-1840
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No132700000XDietary & Nutritional Service ProvidersDietary Manager