Individual
OLIVE MBULAMBO SHAMAKWETE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2067 S CORONADO WAY, BOISE, ID 83709-2597
(208) 570-9605
Mailing address
2067 S CORONADO WAY, BOISE, ID 83709-2597
(208) 570-9605
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106S00000X
—
ID
Enumeration date
08/18/2021
Last updated
08/18/2021
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