| NPI | 1376078303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN MOSS Owner 208-818-6181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ AP8631) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2021-06-10 |