Individual
BEVERLY PAIGE BENNION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4980 W STATE ST STE A, BOISE, ID 83703-3326
(208) 639-1649
(208) 639-0813
Mailing address
2055 GARRETT WAY, STE 1, POCATELLO, ID 83201-5100
(208) 236-1600
(208) 236-6695
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
ID
3747P1801X
Personal Care Attendant
—
ID
376J00000X
Homemaker
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144470493
—
ID
Enumeration date
09/23/2008
Last updated
10/02/2018
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