Individual
SHANE ROBINSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
131 W BRIDGE ST, BLACKFOOT, ID 83221-2704
(208) 782-0990
Mailing address
PO BOX 232, BLACKFOOT, ID 83221-0232
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/23/2020
Last updated
03/23/2020
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