NPI age
15 years
Enumerated 2010-06-10
Across 1280 active nurse practitioner providers in Idaho.
3 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 003399100 | |
| 05 (ID) | 1669792859 |
Part of a multi-provider practice. 28 other active providers share this practice address in NPPES.
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