Individual
SHELLY MAE LUMMUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
207 E 12TH ST, EMMETT, ID 83617-3626
(208) 365-1065
(208) 365-1065
Mailing address
207 E 12TH ST, EMMETT, ID 83617-3626
(208) 365-1065
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
THW000111135
OR
Other
Enumeration date
08/05/2024
Last updated
08/05/2024
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