Individual
MISS HALEY NICOLE MORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
745 BUENA VISTA DR # 82520, LANDER, WY 82520-3431
(307) 332-2941
Mailing address
5890 S SWEET GUM WAY, BOISE, ID 83716-6968
(208) 298-7443
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/28/2021
Last updated
09/28/2021
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