NPI age
20 years
Enumerated 2006-05-10
Across 658 active nurse practitioner providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 807415800 | MEDICAID |
| 05 (WA) | 9648015 |
Part of a multi-provider practice. 9 other active providers share this practice address in NPPES.
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