Individual
KATEE JO RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1441 NE 10TH AVE, PAYETTE, ID 83661-5420
(208) 642-9376
(208) 642-9598
Mailing address
1441 NE 10TH AVE, PAYETTE, ID 83661-5420
(208) 642-9376
(208) 642-9598
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00000
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
IDAHO LICENSE PENDING
ID
Enumeration date
09/19/2012
Last updated
09/19/2012
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