| NPI | 1457839730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN JILL ROTH Owner 208-242-3723 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID np1287a) |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2020-04-10 |