| NPI | 1194686667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE HYNDS Owner 208-960-4606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2025-11-22 |
| Last Update Date | 2025-11-22 |