Individual
KATELYN ROSE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3230 NINA DR, IDAHO FALLS, ID 83404-7428
(208) 243-6077
Mailing address
3230 NINA DR, IDAHO FALLS, ID 83404-7428
(208) 243-6077
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4071550
ID
Other
Enumeration date
02/26/2025
Last updated
02/26/2025
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