Individual
ANGELICA DE VINCENZIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
875 PERIMETER DR, MOSCOW, ID 83844-9803
(208) 885-1673
Mailing address
292 BAKER ST APT 201, MOSCOW, ID 83843-7006
(985) 510-3046
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
ID
Other
Enumeration date
08/15/2024
Last updated
08/15/2024
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