| NPI | 1538668421 |
|---|---|
| Doing Business As | EVERGREEN PHYSICAL MEDICINE |
| Entity Type | Organization |
| Authorized Contact | SUMMER DANCE Executive Director 208-895-8595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2018-02-06 |