Individual
SELENA NICKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2450 E 25TH ST, IDAHO FALLS, ID 83404-7577
(208) 656-5858
(205) 549-7575
Mailing address
32 CARLSON AVE, REXBURG, ID 83440-1914
(208) 557-3516
(208) 549-7575
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
02/05/2018
Last updated
02/05/2018
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