Individual
EDNA MAE PALMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3798 W 500 S, MALAD CITY, ID 83252-6105
(208) 251-9808
Mailing address
3798 W 500 S, MALAD CITY, ID 83252-6105
(208) 251-9808
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
32160
ID
Other
Enumeration date
12/06/2019
Last updated
12/06/2019
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