Individual
LITA ELAINE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSFA
Contact information
Practice address
2845 SW HEATON LN, MOUNTAIN HOME, ID 83647-6409
(208) 803-8246
Mailing address
2845 SW HEATON LN, MOUNTAIN HOME, ID 83647-6409
(208) 803-8246
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
100102656
ID
Other
Enumeration date
10/27/2025
Last updated
10/27/2025
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