Individual
LACIE DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1118 F ST, LEWISTON, ID 83501-1930
(208) 899-9405
Mailing address
1118 F. ST, LEWISTON, ID 83501
(208) 899-9405
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
N-50935
ID
Other
Enumeration date
04/20/2016
Last updated
04/20/2016
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