| NPI | 1023762119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER JANE VAN SICKLE-BIRCH Owner 208-557-3870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2022-02-08 |