Provider Demographics
NPI:1912511213
Name:OHLS, IRENE M (CNA, PHLEBOTOMIST)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:M
Last Name:OHLS
Suffix:
Gender:F
Credentials:CNA, PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 AUSTRIAN SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:HOMEDALE
Mailing Address - State:ID
Mailing Address - Zip Code:83628-3611
Mailing Address - Country:US
Mailing Address - Phone:208-994-9377
Mailing Address - Fax:
Practice Address - Street 1:322 W LOGAN ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-1710
Practice Address - Country:US
Practice Address - Phone:208-994-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID00038610602251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health