Individual
TAMMY JO DAYLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
267 N CANYON DR, GOODING, ID 83330-5500
(208) 934-4446
(208) 934-4442
Mailing address
267 N CANYON DR, GOODING, ID 83330-5500
(208) 934-4446
(208) 934-4442
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1370131
MEDICARE PART B
ID
Enumeration date
03/12/2018
Last updated
03/12/2018
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