Individual
MARY LAREE KENWORTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 W FORT ST BLDG 88, BOISE, ID 83702-4598
(208) 422-1000
(208) 422-1591
Mailing address
500 W FORT ST BLDG 88, BOISE, ID 83702-4598
(208) 422-1000
(208) 422-1591
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
8104
ID
164W00000X
Licensed Practical Nurse
Primary
PN8104
ID
Other
Enumeration date
08/31/2020
Last updated
08/31/2020
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