NPI age
20 years
Enumerated 2005-11-10
Across 658 active nurse practitioner providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (CA) | GR0067130 | |
| 01 (CA) | ZZZ28485Z | BLUE SHIELD |
Part of a multi-provider practice. 8 other active providers share this practice address in NPPES.
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