Individual
WESLEY WARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
134 W CHUBBUCK RD, CHUBBUCK, ID 83202-2338
(208) 237-7911
(208) 237-3450
Mailing address
4823 NAVAJO ST, POCATELLO, ID 83204-3719
(208) 221-4931
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
58903
ID
Other
Enumeration date
07/15/2018
Last updated
07/15/2018
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