| NPI | 1154188050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW FOWLER Nurse Practitioner/Owner 208-546-3650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 363LA2200X Nurse Practitioner Adult Health | |
| Enumeration Date | 2024-03-06 |
| Last Update Date | 2025-05-28 |