Individual
KRISTY NICOLE LAGESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1159 E IRON EAGLE DR, EAGLE, ID 83616-6871
(425) 471-1603
Mailing address
18197 ROYAL WAY, NAMPA, ID 83687-9095
(425) 471-1603
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-4406
ID
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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