Individual
JORDAN PATRICK BELLUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AUD
Contact information
Practice address
172 2ND ST S, NAMPA, ID 83651-3708
(208) 385-3260
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
81238
TX
Other
Enumeration date
08/10/2020
Last updated
12/06/2021
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