Individual
SYDNEY SHORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
709 DEARBORN ST, CALDWELL, ID 83605-4116
(208) 376-7083
Mailing address
709 DEARBORN ST, CALDWELL, ID 83605-4116
(208) 376-7083
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/09/2024
Last updated
07/09/2024
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