Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 99 | ID |
NPI | 1750944344 |
---|---|
Provider Name | Amanda Jodi Rowe |
First Address | Coeur D Alene, ID 83814-3221 |
Second Address | Boise, ID 83704-5477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2019 |
Last Update Date | 18/04/2019 |