Individual
ANGELA GREGORY UPDIKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
168 ROSEMARY LOOP # 2, PRIEST LAKE, ID 83856-5023
(208) 304-0383
Mailing address
PO BOX 744, PRIEST RIVER, ID 83856-0744
(208) 304-0383
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0019006484
VA
Other
Enumeration date
10/09/2007
Last updated
10/09/2007
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