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1275261059
KATIE DIANE MADDOCK
IDAHO FALLS, ID
NPI
1275261059
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
Enumeration Date
2022-08-10
Last Update Date
2024-11-23
Business Address
KATIE DIANE MADDOCK
1550 ELK CREEK DR
IDAHO FALLS, ID 83404-8322
Phone number: 208-529-5942
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Mailing Address
KATIE DIANE MADDOCK
1550 ELK CREEK DR
IDAHO FALLS, ID 83404-8322
Phone number: 208-529-5942
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