NPI age
19 years
Enumerated 2006-12-19
Across 658 active nurse practitioner providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1245393131 | |
| 01 (ID) | NP416A | LICENSE |
Part of a multi-provider practice. 18 other active providers share this practice address in NPPES.
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