Individual
MRS. BRANDI ADELE MACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IDMT
Contact information
Practice address
84 BOMBER RD, MOUNTAIN HOME A F B, ID 83648-5272
(208) 828-3604
Mailing address
1410 KURSTEN ST, MOUNTAIN HOME, ID 83647-4646
(505) 264-9784
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
05/04/2009
Last updated
05/04/2009
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