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Individual

MEGAN RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
430 W IOWA AVE STE A, NAMPA, ID 83686-2826
(208) 442-1123
Mailing address
430 W IOWA AVE STE A, NAMPA, ID 83686-2826

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-230
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MASG-230
BUREAU OF OCCUPATIONAL LICENSES
ID
Enumeration date
03/17/2017
Last updated
03/17/2017
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