Organization
STANLEY J WATERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY ANN BUCKLEY RN (RNFA)
(208) 870-2689
Entity
Organization
Contact information
Practice address
1795 S SUB STATION RD, EMMETT, ID 83617-9431
(208) 870-2689
Mailing address
1795 S SUB STATION RD, EMMETT, ID 83617-9431
(208) 870-2689
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
N-36730
ID
Other
Enumeration date
09/07/2012
Last updated
09/07/2012
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