Individual
MRS. THERESA WHITLOCK-WILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2678 W SORBONNE DR, COEUR D ALENE, ID 83815-6044
(208) 625-0467
Mailing address
2678 W SORBONNE DR, COEUR D ALENE, ID 83815-6044
(208) 625-0467
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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