Individual
VICKEY SCHMADEKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8565 W STONEHAVEN ST, BOISE, ID 83704-7079
(541) 805-0028
Mailing address
8565 W STONEHAVEN ST, BOISE, ID 83704-7079
(541) 805-0028
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MAS-2130
ID
Other
Enumeration date
02/18/2015
Last updated
02/18/2015
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