Evan White

NPI #1043038268 in Emmett, Idaho

Provider Information

NPI Number: 1043038268
Entity Type: Individual
Name: Evan White
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Sep 27, 2024
Last Updated: Sep 27, 2024

Practice Location

Address: 9825 MAYBERRY LN
City: Emmett
State: Idaho
ZIP Code: 83617-3051
Phone: (208) 713-1290

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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