Individual
MR. DWAYNE L. MILLWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RRT
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
500 W FORT ST, BOISE, ID 83702-4501
(208) 411-1356
Taxonomy
Speciality
Code
Description
License number
State
2279C0205X
Critical Care Registered Respiratory Therapist
Primary
LRT-362
ID
Other
Enumeration date
06/29/2021
Last updated
06/29/2021
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