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1366558579
NICHOLAS L REFVEM
MOSCOW, ID
NPI
1366558579
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: ID AT-218)
Enumeration Date
2006-08-21
Last Update Date
2007-07-08
Business Address
Mr. NICHOLAS L REFVEM ATC
124 KIBBIE ACTIVITY CTR BOX 442302
MOSCOW, ID 83844-2302
Phone number: 208-885-0212
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Mailing Address
Mr. NICHOLAS L REFVEM ATC
819 TRUMAN ST
MOSCOW, ID 83843-9540
Phone number: 208-596-2998
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