Healthcare Provider Details

I. General information

NPI: 1891209854
Provider Name (Legal Business Name): MARTA LUCIA MARIE HALE RT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTA LUCIA MARIE HALE RT

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S WOODRUFF AVE STE B
IDAHO FALLS ID
83404-6374
US

IV. Provider business mailing address

93 N 285 E
BLACKFOOT ID
83221-5987
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-2498
  • Fax: 208-528-7971
Mailing address:
  • Phone: 208-705-5497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278P1006X
TaxonomyPulmonary Function Technologist Certified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: