Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156F00000X | Technician/Technologist | EEI232029 | ID |
NPI | 1124788153 |
---|---|
Provider Name | Ms. Janean White |
First Address | Chubbuck, ID 83202-1666 |
Second Address | Pocatello, ID 83204-3261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2021 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
EEI232029 | BUREAU OF OCCUPATIONAL LICENSES (01) | ID |
EEI232029 | BUREAU OF OCCUPATIONAL LISCENSE (01) | ID |