Individual
BRIANNE HENTRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
233 GOODING ST N, TWIN FALLS, ID 83301-6179
(208) 736-5048
(208) 735-2126
Mailing address
233 GOODING ST N, TWIN FALLS, ID 83301-6179
(208) 736-5048
(208) 735-2126
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558606962
—
ID
Enumeration date
01/22/2014
Last updated
01/22/2014
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