Individual
SHANDRA DEE AVERETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-4100
Mailing address
357 W 170 N, BLACKFOOT, ID 83221-5614
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
58040
ID
367A00000X
Advanced Practice Midwife
—
—
Other
Enumeration date
03/05/2018
Last updated
07/23/2021
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