KAISSA DESTA IDAHOSA

MARIETTA, GA
NPI1942955323
Former NameKAISSA BENTH
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: GA  RN227597)
Additional Taxonomies363L00000X Nurse Practitioner
(Licence: GA  RN227597)
Enumeration Date2022-02-15
Last Update Date2024-10-03
Business Address
KAISSA DESTA IDAHOSA NP
2480 WINDY HILL RD SE
MARIETTA, GA 30067-8644
Phone number: 800-640-3451
Mailing Address
KAISSA DESTA IDAHOSA NP
PO BOX 1200
PLEASANT GROVE, UT 84062-1200
Phone number: 800-640-3451