Individual
KATELYN BRIGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
450 W STATE ST, EAGLE, ID 83616-7057
(208) 939-1035
(208) 939-8970
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M-17891
ID
Other
Enumeration date
04/05/2021
Last updated
09/05/2024
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