| NPI | 1053589432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMI CHARLTON Office Manager 208-734-3455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID N24873) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2008-02-19 |