Individual
AUDREY DALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
496 A ST, IDAHO FALLS, ID 83402-3617
(208) 552-7100
(208) 552-7101
Mailing address
299 JEFFERSON ST, BLACKFOOT, ID 83221-1818
(208) 785-5152
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN8030
ID
Other
Enumeration date
08/30/2006
Last updated
07/09/2007
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