NPI age
19 years
Enumerated 2007-03-19
Across 245 active psychiatry & neurology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010146503 | BLUE SHIELD INDIVIDUAL |
| 05 (ID) | 806503100 | |
| 01 (ID) | S4802 | BLUE CROSS INDIVIDUAL |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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