Individual
LORA OMAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
16943 OLD FRIENDSHIP WAY, CALDWELL, ID 83607-4502
(208) 570-9083
Mailing address
16943 OLD FRIENDSHIP WAY, CALDWELL, ID 83607-4502
(208) 570-9083
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
59610
ID
Other
Enumeration date
12/11/2023
Last updated
12/11/2023
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