| NPI | 1366274201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JED ROBERTSON CEO 208-529-3342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-08-20 |