Individual
SHIRLEY YELLOWHAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
1950 E CLARK ST, STE A, POCATELLO, ID 83201
(208) 232-5550
(208) 232-5553
Mailing address
PO BOX 4948, POCATELLO, ID 83201
(208) 232-5550
(208) 232-5553
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
050663
ID
Other
Enumeration date
12/21/2006
Last updated
07/08/2007
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