NPI age
19 years
Enumerated 2007-01-17
Across 228 active obstetrics & gynecology providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (LA) | L023779 | STATE LICENSE |
| 05 (CO) | 9000166884 | |
| 05 (LA) | 1487163 |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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