NPI age
19 years
Enumerated 2006-07-31
Across 658 active nurse practitioner providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 805146700 | |
| 01 (ID) | 000010015819 | REGENCE BLUE SHIELD |
| 01 (ID) | NP659 | BLUE CROSS |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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