Individual
CAITLINN KUUIPO TANAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4835 TRENT ST, CHUBBUCK, ID 83202-2955
(208) 241-6815
(208) 241-6815
Mailing address
4835 TRENT ST, CHUBBUCK, ID 83202-2955
(208) 241-6815
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN-46661
ID
Other
Enumeration date
07/10/2017
Last updated
07/10/2017
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