| NPI | 1356475115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LOU KOELSCH Office Manager 208-587-5880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M3819) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID NP382A) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2013-09-20 |