Individual
LESLIE ANNETTE HAVRILAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4521 THOMAS JEFFERSON ST, CALDWELL, ID 83605-5100
(208) 454-4820
Mailing address
4521 THOMAS JEFFERSON ST, CALDWELL, ID 83605-5100
(208) 454-4820
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
58087
ID
Other
Enumeration date
05/22/2020
Last updated
05/22/2020
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