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Individual

MR. JEFFREY ROBERTS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPN,WCN

Contact information

Practice address
620 S ELDER ST, NAMPA, ID 83686-5212
(208) 465-7659
Mailing address
620 S ELDER ST, NAMPA, ID 83686-5212
(208) 465-7659

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN-15716
ID

Other

Enumeration date
07/16/2014
Last updated
07/16/2014
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