| NPI | 1063764462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER FLETCHER Owner Nurse Practioner 208-758-0560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2022-08-26 |