Healthcare Provider Details

I. General information

NPI: 1427974534
Provider Name (Legal Business Name): CAYLIE MAE DOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 REMEMBER DR
AMMON ID
83406-5050
US

IV. Provider business mailing address

1020 LAND BANK ST
IDAHO FALLS ID
83402-1809
US

V. Phone/Fax

Practice location:
  • Phone: 208-604-0297
  • Fax:
Mailing address:
  • Phone: 208-604-0297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: