TAI BANTA

IDAHO FALLS, ID
NPI1467185843
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2022-07-05
Last Update Date2026-08-12
Business Address
TAI BANTA
3425 MERLIN DR STE 200
IDAHO FALLS, ID 83404-7430
Phone number: 208-528-6653
Mailing Address
TAI BANTA
3425 MERLIN DR STE 200
IDAHO FALLS, ID 83404-7430
Phone number: 208-528-6653