| NPI | 1033424429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKNEY RAEANNE BORRON Owner 208-866-1428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-923A) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2013-02-28 |