Individual
NICOLE LYNN REAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
815 N 6TH E, MOUNTAIN HOME, ID 83647-2207
(208) 580-2001
Mailing address
815 N 6TH E, MOUNTAIN HOME, ID 83647-2207
(208) 580-2001
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
71011
ID
Other
Enumeration date
03/15/2023
Last updated
03/15/2023
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