Individual
MS. SALLY KUPCHOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1182 E 21ST ST, IDAHO FALLS, ID 83404-7003
(208) 227-6753
Mailing address
1182 E 21ST ST, IDAHO FALLS, ID 83404-7003
(208) 227-6753
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP737A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NPXT3
BLUE CROSS ID
ID
Enumeration date
07/10/2006
Last updated
11/30/2007
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