ARIEL SHANTAY AVIS TAYSOM

MALAD CITY, ID
NPI1609341098
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: ID  PA-1656)
Enumeration Date2018-10-11
Last Update Date2021-11-16
Business Address
ARIEL SHANTAY AVIS TAYSOM PA-C
220 BANNOCK ST
MALAD CITY, ID 83252-5068
Phone number: 208-766-2600
Mailing Address
ARIEL SHANTAY AVIS TAYSOM PA-C
220 BANNOCK ST
MALAD CITY, ID 83252-5068
Phone number: 208-766-2600
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