Individual
MR. DUSTIN JAY FIELDSTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
337 W IOWA AVE, NAMPA, ID 83686
(208) 467-7889
(208) 467-7800
Mailing address
337 W IOWA AVE, NAMPA, ID 83686
(208) 467-7889
(208) 467-7800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT-1955
ID
Other
Enumeration date
09/28/2006
Last updated
07/08/2007
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