Individual
WALTER O LOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN, CWCA
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4599
(208) 504-8354
(208) 422-1106
Mailing address
500 W FORT ST, BOISE, ID 83702-4501
(208) 504-8354
(208) 422-1106
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
10822
ID
Other
Enumeration date
06/13/2022
Last updated
06/13/2022
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