Individual
PATRICIA SUTHERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
622 CENTER ST W, KIMBERLY, ID 83341-1720
(208) 490-0203
Mailing address
3636 N 3600 E, KIMBERLY, ID 83341-5321
(208) 490-0203
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
MID-91
ID
Other
Enumeration date
10/16/2018
Last updated
10/16/2018
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