Individual
NICOLE K WHITING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1065 E WINDING CREEK DR STE 250, EAGLE, ID 83616-7246
(208) 805-2324
Mailing address
1047 SCHULTZ RD, MOSCOW, ID 83843-8120
(208) 310-1261
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
PSB94028303
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
SE-203972
ID
Other
Enumeration date
09/03/2024
Last updated
09/03/2024
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