Individual
SHAWNEE B LEGARRETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
605 11TH AVE E, GOODING, ID 83330-5368
(208) 934-8461
(208) 934-5437
Mailing address
605 11TH AVE E, GOODING, ID 83330-5368
(208) 934-8461
(208) 934-5437
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
N45891
ID
Other
Enumeration date
10/20/2014
Last updated
10/20/2014
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