Individual
NICHOLAS JOHN BROWNELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
610 OAK ST, POTLATCH, ID 83855-0359
(208) 351-8968
Mailing address
610 OAK ST, POTLATCH, ID 83855-0359
(208) 351-8968
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0003385
—
ID
Enumeration date
04/24/2019
Last updated
10/12/2019
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