NPI age
19 years
Enumerated 2006-10-11
Across 56 active nurse practitioner providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 13417641 | MEDICARE INDIVIDUAL PTAN |
| 01 (ID) | 1370066 | MEDICARE GROUP PTAN |
| 05 (ID) | 804142500 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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