Individual
MISS KATHLEEN L LACASSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IDMT
Contact information
Practice address
90 HOPE DRIVE BLDG 6000, MOUNTIAN HOME AFB, ID 83648
(208) 828-7401
Mailing address
90 HOPE DRIVE BLDG 6000, MOUNTIAN HOME AFB, ID 83648
(860) 921-6527
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
04/15/2022
Last updated
06/26/2023
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