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1891555025
TYRAY M PETTY
BOISE, ID
NPI
1891555025
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
172V00000X Community Health Worker
Additional Taxonomies
171M00000X Case Manager/Care Coordinator
Enumeration Date
2024-03-22
Last Update Date
2024-03-22
Business Address
TYRAY M PETTY
6305 W OVERLAND RD
BOISE, ID 83709-3029
Phone number: 208-605-3663
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Mailing Address
TYRAY M PETTY
6305 W OVERLAND RD
BOISE, ID 83709-3029
Phone number: 208-605-3663
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