Individual
JUDY A METELKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS,ARNP
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 743-2511
(208) 799-5554
Mailing address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 743-2511
(208) 799-5554
Taxonomy
Speciality
Code
Description
License number
State
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
Primary
CNS-1A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10017766
REGENCE OF IDAHO
ID
05
—
805366200
—
ID
01
—
8C576
BLUE CROSS OF IDAHO
ID
05
—
9627472
—
WA
01
—
HBUR5
IDAHO BLUE CROSS IND
ID
Enumeration date
02/02/2007
Last updated
07/09/2007
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