NPI age
19 years
Enumerated 2006-08-13
Across 658 active nurse practitioner providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 806116100 | |
| 01 (ID) | NPGD5 | BLUE CROSS |
| 01 (ID) | 0000100034952 | BLUE SHIELD |
Part of a multi-provider practice. 17 other active providers share this practice address in NPPES.
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