Individual
SENGPRASEUTH JOHNNY LUANGAPHAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
(208) 422-1051
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
41733
ID
Other
Enumeration date
03/10/2022
Last updated
03/10/2022
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