Individual
JONAS DETHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
239 WINGED FOOT PL, EAGLE, ID 83616-5265
(208) 473-0493
Mailing address
239 WINGED FOOT PL, EAGLE, ID 83616-5265
(208) 473-0493
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
10/02/2021
Last updated
10/02/2021
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