| NPI | 1568087005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE FUNKE Owner/A RN P 208-816-8746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2020-06-10 |