Individual
A SHURAVLOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 529-6111
Mailing address
30207 US 2, SULTAN, WA 98294-8693
(360) 793-0201
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP61542694
WA
Other
Enumeration date
03/29/2021
Last updated
09/12/2024
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