Individual
SHANNIELLE LOUISE BAIRD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 529-6111
(208) 529-7021
Mailing address
PO BOX 277381, ATLANTA, GA 30384-7381
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
56461
ID
363LF0000X
Family Nurse Practitioner
56461
ID
Other
Enumeration date
08/07/2017
Last updated
04/19/2022
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