Individual
LAUREN ADDISON MANFULL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
315 W COLLEGE AVE, ST MARIES, ID 83861-2035
(208) 568-0082
Mailing address
100 DUGGER ST, ST MARIES, ID 83861-2434
(208) 568-0082
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/20/2011
Last updated
07/20/2011
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