Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | LMSW-40800 | ID |
NPI | 1003481763 |
---|---|
Provider Name | Miranda Arisbet Hernandez |
First Address | Payette, ID 83661-2853 |
Second Address | Payette, ID 83661-2853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2021 |
Last Update Date | 25/05/2021 |