Individual
MR. LEVI HAKANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4847 W TALAMORE DR, MERIDIAN, ID 83646-8846
(208) 509-9868
Mailing address
2056 KELLY DR, PAYETTE, ID 83661-5013
(208) 509-9868
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
ID
Other
Enumeration date
11/13/2025
Last updated
11/13/2025
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