NPI age
19 years
Enumerated 2006-06-02
Across 1280 active nurse practitioner providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 807769000 | |
| 01 | 1345621 | PTAN |
Part of a multi-provider practice. 17 other active providers share this practice address in NPPES.
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