Individual
ALYSSA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1351 W PINE AVE, MERIDIAN, ID 83642-5031
(208) 895-6431
Mailing address
197 E MALLARD DR APT 130, BOISE, ID 83706-6619
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
02/22/2018
Last updated
02/22/2018
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