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1649664442
TRACY JO ELLIS
HAYDEN LAKE, ID
NPI
1649664442
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
171W00000X Contractor
(Licence: ID MAS-1492)
Enumeration Date
2015-03-19
Last Update Date
2015-03-19
Business Address
-- TRACY JO ELLIS LMT
157 W HAYDEN AVE
HAYDEN LAKE, ID 83835-9650
Phone number: 509-216-3663
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Mailing Address
-- TRACY JO ELLIS LMT
1628 W JUDY K DR
RATHDRUM, ID 83858-7502
Phone number: 509-216-3663
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