Individual
TAYLOR ANN TRUESDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
502 S EAGLE RD, MERIDIAN, ID 83642
(208) 706-5000
Mailing address
1710 EMERALD AVE, CALDWELL, ID 83605-4794
(208) 230-3878
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-772
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000038852
BOC NUMBER
—
01
—
AT-772
STATE LICENSURE NUMBER
ID
Enumeration date
06/01/2018
Last updated
11/16/2021
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