Individual
MICHELLE LEA THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
795 WALNUT ST N, TWIN FALLS, ID 83301-4140
(208) 404-4853
Mailing address
795 WALNUT ST N, TWIN FALLS, ID 83301-4140
(208) 404-4853
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
ID
Enumeration date
03/21/2009
Last updated
03/21/2009
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