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Individual

CAROL LADLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
F.N.P.-C

Contact information

Practice address
15 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2057
(208) 356-6185
(208) 356-0378
Mailing address
15 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2057
(208) 356-6185
(208) 356-0378

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-481A
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
NP-481A
IDAHO LICENSE
ID
Enumeration date
11/29/2006
Last updated
07/08/2007
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