institution
Carmine Petracca
Health Service Clinic/Center in Lewiston, Idaho
NPI 1649601006

Carmine Petracca is a Health Service Clinic/Center based in Lewiston, ID and is specialized in Health Service. Carmine Petracca practices in Lewiston, ID. The NPI Number for Carmine Petracca is 1649601006 and holds a License No. ODP-634 (Idaho).

The current practice location address for Carmine Petracca is 939 Bryden Ave, Lewiston, ID and can be reached out via phone at 208-743-1761 and via fax at 208-746-8042.

Location: 939 Bryden Ave, Lewiston, ID, 83501-5057
institution
Provider Profile Details
NPI Number
1649601006
Provider Name
Carmine Petracca
Credential
Provider Entity Type
Organization
Address
939 Bryden Ave, Lewiston, ID, 83501-5057
Phone Number
208-743-1761
Fax Number
208-746-8042
Provider Enumeration Date
12/10/2013
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
939 Bryden Ave
City
State
Zip
83501-5057
Phone Number
208-743-1761
Fax Number
208-746-8042
person
Provider Business Mailing Address Details
Address
939 Bryden Ave
City
State
Zip
83501-5057
Phone Number
208-743-1761
Fax Number
208-746-8042
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Health Service
Taxonomy
License No.
ODP-634 (Idaho)
Definition
Definition to come...
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