Individual
BROOKE DYAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
417 S 6TH ST, BOISE, ID 83702
(208) 577-4460
Mailing address
12193 S RED HAWK PL, NAMPA, ID 83686
(503) 313-1214
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
67171
ID
Other
Enumeration date
05/08/2023
Last updated
05/08/2023
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