NPI age
10 years
Enumerated 2016-03-29
Across 806 active community/behavioral health providers in Idaho.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 1366773020 | INDIVIDUAL IPN |
Multi-provider organization. 1 individual provider on file at this primary address.
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