Individual
LORENA HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1720 N WESTGATE DR, SUITE A-1, BOISE, ID 83704-7164
(208) 334-0808
Mailing address
6299 S SOLAR WAY, BOISE, ID 83709-8606
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/28/2016
Last updated
03/28/2016
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