| NPI | 1134841711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TENAE DANA Office Manager/Billing 208-461-5716 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2023-01-19 |