Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MASG-282 | ID |
NPI | 1831591445 |
---|---|
Provider Name | Maja Page Mcknight |
First Address | Pocatello, ID 83201-3747 |
Second Address | Pocatello, ID 83201-4530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2014 |
Last Update Date | 25/09/2014 |