Individual
KATRINA LARENE MACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1047 S WELLS ST, MERIDIAN, ID 83642-7997
(208) 297-3428
(208) 297-3978
Mailing address
1070 MAPLEWOOD ST, BURLEY, ID 83318-5511
(208) 431-4898
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
78422
ID
Other
Enumeration date
01/05/2024
Last updated
05/28/2024
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