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Leslie Annette Havrilak

Registered Nurse in Caldwell, ID. Individual provider (NPI-1).

NPI number1164045274
StatusActive
Last updated in NPPESMay 22, 2020

Details

NPI
1164045274
Entity type
Individual (NPI-1)
Name
Leslie Annette Havrilak
Sex
Female
Sole proprietor
No
Enumeration date
May 22, 2020
Certification date
May 22, 2020
Last updated
May 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
163W00000X Registered Nurse58087IDYes

Practice location

4521 Thomas Jefferson St
Caldwell, ID 83605-5100

Phone 208-454-4820

Mailing address

4521 Thomas Jefferson St
Caldwell, ID 83605-5100

Phone 208-454-4820

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