Individual
EBEREGBULAM AMAECHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3132 S CANYON ST, NAMPA, ID 83686-8378
(208) 440-4411
Mailing address
3132 S CANYON ST, NAMPA, ID 83686-8378
(208) 440-4411
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0003766
—
ID
Enumeration date
03/18/2022
Last updated
03/18/2022
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