NPI age
19 years
Enumerated 2006-11-06
Across 1263 active physician assistant providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (NV) | 1689743700 | |
| 01 | 12428227 | CAQH |
Part of a multi-provider practice. 17 other active providers share this practice address in NPPES.
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