Individual
MAIALISA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2290 ROBB ST, IDAHO FALLS, ID 83402-2969
(208) 520-5406
Mailing address
2290 ROBB ST, IDAHO FALLS, ID 83402-2969
(208) 520-5406
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/27/2023
Last updated
09/27/2023
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