Individual
MELISSA A HATHHORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
360 E LIBERTY ST, WEISER, ID 83672-2261
(208) 549-4424
Mailing address
1024 W 2ND ST, WEISER, ID 83672-1809
(360) 798-8127
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
67969
ID
Other
Enumeration date
04/21/2021
Last updated
04/21/2021
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