Provider Demographics
NPI:1316799471
Name:MAISEY, ADALINDA
Entity type:Individual
Prefix:
First Name:ADALINDA
Middle Name:
Last Name:MAISEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADALINDA
Other - Middle Name:
Other - Last Name:MAISEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-0302
Mailing Address - Country:US
Mailing Address - Phone:208-878-8887
Mailing Address - Fax:
Practice Address - Street 1:1321 OAKLEY AVE STE 2
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1894
Practice Address - Country:US
Practice Address - Phone:208-878-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Multi-Specialty