Individual
SHELLEY LEILANI DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
3614 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7573
(208) 552-7700
(208) 552-1786
Mailing address
3614 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7573
(208) 552-7700
(208) 552-1786
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
TLP-014
ID
Other
Enumeration date
11/05/2013
Last updated
11/05/2013
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