NPI age
20 years
Enumerated 2006-01-31
Across 1263 active physician assistant providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (NV) | 1235100991 | |
| 05 (NV) | 100507371 | |
| 01 (NV) | 100508544 | MEDICAID |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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