| NPI | 1487260550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA LYNN PIKE Administrator 208-985-2260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2020-10-15 |