Organization
CDE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATALIE DOMANGUE-SHIFLETT MD (DIRECTOR)
(208) 965-0905
Entity
Organization
Contact information
Practice address
13150 W PERSIMMON LN, BOISE, ID 83713-1986
(208) 965-0905
Mailing address
13150 W PERSIMMON LN, BOISE, ID 83713-1986
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
07/27/2019
Last updated
07/27/2019
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