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Individual

MS. MYRNA LEE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
P.A.-C

Contact information

Practice address
1740 E 17TH ST, SUITE A, IDAHO FALLS, ID 83404-6375
(208) 346-7500
(208) 346-7501
Mailing address
1740 E 17TH ST, SUITE A, IDAHO FALLS, ID 83404-6375
(208) 346-7500
(208) 346-7501

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA334
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
806327800
ID
Enumeration date
08/29/2006
Last updated
05/18/2009
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