NPI age
14 years
Enumerated 2011-06-14
Across 1280 active nurse practitioner providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1407141856 | |
| 01 (ID) | NP-1009A | STATE LICENSE |
| 01 (ID) | P00954635 | MEDICARE RAILROAD CARRIER |
Part of a multi-provider practice. 58 other active providers share this practice address in NPPES.
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