Individual
KELLY IVA WUTHRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4599
(208) 422-1021
Mailing address
3022 N KUBIK PL, MERIDIAN, ID 83646-8240
(208) 514-5124
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
N-27621
ID
Other
Enumeration date
01/05/2023
Last updated
01/05/2023
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