MADDIE A WAGONER

POCATELLO, ID
NPI1871200766
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2022-11-01
Last Update Date2022-11-01
Business Address
MADDIE A WAGONER ATS
1110 E HALLIDAY ST
POCATELLO, ID 83201-4824
Phone number: 208-851-8361
Mailing Address
MADDIE A WAGONER ATS
1110 E HALLIDAY ST
POCATELLO, ID 83201-4824
Phone number: 208-851-8361