Individual
MICHELLE LEE ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(541) 460-0215
Mailing address
359 S LONG BAY WAY, STAR, ID 83669-5107
(541) 460-0215
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
57689
ID
Other
Enumeration date
08/04/2019
Last updated
08/04/2019
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