Individual
KAILYN WIERSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1620 S CELEBRATION AVE, MERIDIAN, ID 83642-2779
(208) 884-1030
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301112092
MI
208000000X
Pediatrics Physician
4301501833
MI
208000000X
Pediatrics Physician
Primary
M-16194
ID
Other
Enumeration date
05/17/2017
Last updated
04/14/2022
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