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Individual

MRS. TERESSA LINDA DURHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
11186 N HAUSER LAKE RD, HAUSER, ID 83854-5638
(208) 457-1515
Mailing address
11186 N HAUSER LAKE RD, HAUSER, ID 83854-5638
(208) 457-1515

Taxonomy

Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
ID

Other

Enumeration date
12/05/2006
Last updated
07/08/2007
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