Individual
SHAWNA THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1888 N EAGLE CREEK WAY, EAGLE, ID 83616-6604
(208) 863-9259
Mailing address
1888 N EAGLE CREEK WAY, EAGLE, ID 83616-6604
(208) 863-9259
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
66420
ID
Other
Enumeration date
11/24/2020
Last updated
11/24/2020
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