Individual
WILDA MAY YATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
62 N UNION ST, STAR, ID 83669
(208) 286-0346
Mailing address
62 N UNION ST, STAR, ID 83669
(208) 286-0346
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
AA134756E
ID
Other
Enumeration date
04/11/2008
Last updated
04/11/2008
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