| NPI | 1689744963 |
|---|---|
| Doing Business As | COLLEEN SHACKELFORD, LLC |
| Entity Type | Organization |
| Authorized Contact | COLLEEN SHACKELFORD Owner 208-342-7400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M5741) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2023-07-25 |