STACI DAWN ELLIS

BOISE, ID
NPI1639519044
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy174400000X Specialist
(Licence: ID  MASG-217)
Enumeration Date2013-06-29
Last Update Date2013-06-29
Business Address
Mrs. STACI DAWN ELLIS LMT
1529 BELMONT ST
BOISE, ID 83725-0001
Phone number: 208-426-1459
Mailing Address
Mrs. STACI DAWN ELLIS LMT
3612 N SUMMERCREST PL
MERIDIAN, ID 83646-7780
Phone number: 208-321-4701
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