Individual
KRISTI LYNN MALICOAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
23220 RIVER RD, GRAND VIEW, ID 83624-5009
(208) 834-2860
Mailing address
PO BOX 632, GRAND VIEW, ID 83624-0632
(208) 834-2860
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
200930022LPN
OR
164W00000X
Licensed Practical Nurse
27036628A
IN
164W00000X
Licensed Practical Nurse
LPN11423
NV
164W00000X
Licensed Practical Nurse
Primary
PN-12009
ID
164X00000X
Licensed Vocational Nurse
VN249377
CA
Other
Enumeration date
04/05/2010
Last updated
05/09/2011
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