NPI age
11 years
Enumerated 2014-07-30
Across 1280 active nurse practitioner providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1043927882 | |
| 01 | 1043503642 | CAQH |
Solo or small practice. No other active providers share this practice address in NPPES.
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