Individual
MR. JASON TERRELL MCNEALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSA, CST
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
212937
ID
246ZS0410X
Surgical Technologist
Primary
5344
ID
Other
Enumeration date
08/26/2022
Last updated
09/22/2022
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