Individual
LAJUANA FLETCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
104 E BATES AVE, PARMA, ID 83660-5034
(208) 695-8419
Mailing address
104 E BATES AVE, PARMA, ID 83660-5034
(208) 695-8419
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-1064
ID
Other
Enumeration date
04/14/2016
Last updated
04/14/2016
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