Individual
NICHOLAS RYAN GENSBURGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LD
Contact information
Practice address
2124 BLAINE ST, CALDWELL, ID 83605-4426
(208) 454-0311
Mailing address
2124 BLAINE ST, CALDWELL, ID 83605-4426
(208) 454-0311
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
LD-136
ID
Other
Enumeration date
02/13/2023
Last updated
02/13/2023
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