| NPI | 1154167682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE SMITH Owner 208-701-2777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2024-07-03 |
| Last Update Date | 2024-07-03 |