Individual
JANA LEE GATTUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LIC ACUPUNCTURIST
Contact information
Practice address
806 MAIN ST, SALMON, ID 83467-4315
(208) 940-0902
Mailing address
88 LOIS LN, SALMON, ID 83467-5326
(208) 940-0902
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
ACU-29
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ACU-29
IDAHO LICENSE NUMBER
ID
Enumeration date
02/04/2019
Last updated
02/04/2019
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