Individual
MR. RANDY PAUL VAWDREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
495 YELLOWSTONE AVE, POCATELLO, ID 83201-4531
(208) 478-7422
Mailing address
1743 DELMAR PLACE, POCATELLO, ID 83201
(208) 238-8145
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
NP-659
ID
Other
Enumeration date
07/12/2006
Last updated
07/09/2007
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