| NPI | 1053521344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD EUGENE CARROLL Owner 208-989-0070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M4116) |
| 363LF0000X Nurse Practitioner, Family (Licence: ID N19189) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-06-14 |