Individual
MR. NICHOLAS L REFVEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
124 KIBBIE ACTIVITY CTR, BOX 442302, MOSCOW, ID 83844-2302
(208) 885-0212
Mailing address
819 TRUMAN ST, MOSCOW, ID 83843-9540
(208) 596-2998
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-218
ID
Other
Enumeration date
08/21/2006
Last updated
07/08/2007
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