Individual
IDALIS AMADALEY LICEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
326 CHARDONNAY AVE, PROSSER, WA 99350-9515
(509) 786-1576
Mailing address
1611 DIAMOND AVE, GRANDVIEW, WA 98930-6118
(509) 786-1576
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
61382393
WA
Other
Enumeration date
06/04/2026
Last updated
06/04/2026
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