Individual
KAYLYNN MARIE-WINWOOD LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 385-3230
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
63946
ID
Other
Enumeration date
02/20/2020
Last updated
05/16/2022
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