Individual
RANDI ORTEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
815 N 6TH E, MOUNTAIN HOME, ID 83647-2207
(208) 580-2001
Mailing address
1005 HIGHWAY 51, MOUNTAIN HOME, ID 83647-5866
(205) 598-0648
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
14540
ID
Other
Enumeration date
07/10/2020
Last updated
07/10/2020
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