NPI age
18 years
Enumerated 2007-07-19
Across 28 active public health or welfare providers in Idaho.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 8077552 |
Doing-business-as, former, and alternate names recorded by NPPES.
Multi-provider organization. 1 individual provider on file at this primary address.
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