Individual
ELVICE MIHALI MWENEMATALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4316 E TAHITI ST, MERIDIAN, ID 83646-6339
(208) 695-1245
Mailing address
4316 E TAHITI ST, MERIDIAN, ID 83646-6339
(208) 695-1245
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87-3194123
87-3194123
ID
Enumeration date
10/20/2021
Last updated
10/20/2021
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