NPI age
20 years
Enumerated 2006-04-19
Across 252 active pediatrics providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010154462 | BLUE SHIELD |
| 05 (ID) | 807354800 | |
| 01 (ID) | 807392600 | HEALTHY CONNECTIONS MCAID |
| 01 (ID) | 76552 | BLUE CROSS |
Part of a multi-provider practice. 18 other active providers share this practice address in NPPES.
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