Individual
JENABELLA D TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10108 W LINCROFT ST, BOISE, ID 83704-5037
(208) 906-4997
Mailing address
10108 W LINCROFT ST, BOISE, ID 83704-5037
(208) 906-4997
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/30/2015
Last updated
09/30/2015
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