Individual
NICOLE MANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
225 E 225 LN S, RUPERT, ID 83350-5080
(208) 219-0451
Mailing address
225 E 225 LN S, RUPERT, ID 83350-5080
(208) 219-0451
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/04/2019
Last updated
09/04/2019
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