| NPI | 1265635171 |
|---|---|
| Other Name | ASTHMA & ALLERGY OF IDAHO MID LEVEL GROUP |
| Entity Type | Organization |
| Authorized Contact | ANDREW WICKERN Credentialing Specialist 208-734-6091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2021-01-14 |