Organization
NOT TSOO GAH NEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLIE ANN ALCORN LPN (LPN)
(208) 238-5427
Entity
Organization
Contact information
Practice address
717 MISSION RD, FT HALL, ID 83203
(208) 238-5427
Mailing address
PO BOX 717 MISSION RD, FT HALL, ID 83203
(208) 238-5427
Taxonomy
Speciality
Code
Description
License number
State
261QP0904X
Federal Public Health Clinic/Center
Primary
PN-15140
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003398900
—
ID
Enumeration date
02/17/2016
Last updated
02/17/2016
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