| NPI | 1205553625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRENTON JENKS Owner/Pharmacist 208-452-7075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2024-07-26 |