Individual
JANENE CALDWELL WITHERITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1077 STELLAR END RD, VICTOR, ID 83455-4973
(307) 690-4683
Mailing address
1077 STELLAR END RD, VICTOR, ID 83455-4973
(307) 690-4683
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
PA-1943
ID
Other
Enumeration date
11/02/2020
Last updated
11/27/2023
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