Individual
PETE N BLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3456 E 17TH ST, AMMON, ID 83406-6757
(541) 941-1543
Mailing address
3456 E 17TH ST, AMMON, ID 83406-6757
(541) 941-1543
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
05/04/2022
Last updated
06/01/2023
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