Individual
LAURA KASALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-7421
Mailing address
10717 W CATMINT DR, STAR, ID 83669-6205
(214) 725-9142
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
29906
ID
Other
Enumeration date
12/08/2021
Last updated
12/08/2021
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