Individual provider · Type 1 NPI

Jacob Daniel Waller

Student in an Organized Health Care Education/Training Program · Moscow, ID

NPI number 1295428191 Active

Practice location

875 Perimeter Dr
Moscow, ID 83844-9803

Call (208) 885-6111 Map

Mailing address

11645 W Cross Slope Way
Nampa, ID 83686-5674

Specialties and licenses

TaxonomyCodeLicense
Speech/Language/Hearing Specialist/Technologist 235500000XNone listed
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

113 other providers at this address

Other student in an organized health care education/training program providers in Moscow

See all in Moscow →

About NPI 1295428191

Jacob Daniel Waller's National Provider Identifier is 1295428191, issued on May 29, 2023. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Moscow, ID. The record was last updated on May 29, 2023.