| NPI | 1427419647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER BIDIMAN Director/Owner 208-596-2701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2025-01-15 |