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 Date2022-10-14
Business Address
TAI BANTA
14107 N 5TH E
IDAHO FALLS, ID 83401-5105
Phone number: 208-881-7462
Mailing Address
TAI BANTA
14107 N 5TH E
IDAHO FALLS, ID 83401-5105
Phone number: 208-881-7462