Individual
LINDA MIKITISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
858 W QUARTER DR, EAGLE, ID 83616-2049
(208) 602-5933
(208) 706-7059
Mailing address
858 W QUARTER DR, EAGLE, ID 83616-2049
(208) 602-5933
(208) 706-7059
Taxonomy
Speciality
Code
Description
License number
State
163WC3500X
Cardiac Rehabilitation Registered Nurse
Primary
38314
ID
Other
Enumeration date
04/10/2018
Last updated
04/10/2018
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