Individual
VANESSA MICHELLE GARDUNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1111 S ORCHARD ST STE 224, BOISE, ID 83705-1922
(208) 971-5034
Mailing address
4422 E SALMON RIVER ST, NAMPA, ID 83686-5174
(208) 971-5034
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
12/13/2023
Last updated
12/13/2023
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