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1114753225
BLAKE SMITH
BOISE, ID
NPI
1114753225
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2024-09-13
Last Update Date
2024-09-13
Business Address
BLAKE SMITH
740 E WARM SPRINGS AVE
BOISE, ID 83712-6420
Phone number: 208-343-7797
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Mailing Address
BLAKE SMITH
2551 SUNNY RIDGE RD APT 104
NAMPA, ID 83686-7568
Phone number: 208-989-3538
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