NPI 1114451390

Sagean Daw

Practitioner Private Vehicle Chubbuck, ID

Practice location

Address: 1624 Angela St, Chubbuck, ID 83202-4100
Phone: (208) 680-8637

Registered specialties

Private Vehicle Primary

Transportation Services Taxonomy 347C00000X Licence EA126126I (ID)

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Registry record

NPI: 1114451390
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Apr 2017
Record last updated: 14 Apr 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.