| NPI | 1013750082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODY FRESTON Owner 208-985-2260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-08-02 |