Individual
BETH LARAE AMOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.F.A
Contact information
Practice address
404 E ELM ST, CALDWELL, ID 83605-4846
(208) 459-0028
(208) 459-0380
Mailing address
12262 W MELLOW CT, BOISE, ID 83709-5180
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
83259
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83259
CERTIFICATION FOR THE SUR
ID
Enumeration date
03/02/2007
Last updated
07/08/2007
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