Individual
MRS. NICOLE ADELLE REYNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 346-7500
Mailing address
1495 ATLANTA ST, IDAHO FALLS, ID 83402-3282
(208) 921-4482
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
09/13/2024
Last updated
09/13/2024
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