Individual
KAELY THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Contact information
Practice address
4389 W AGAVE ST, EAGLE, ID 83616-5308
(208) 670-8704
Mailing address
4389 W AGAVE ST, EAGLE, ID 83616-5308
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
L-144124
ID
Other
Enumeration date
09/28/2020
Last updated
09/28/2020
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