GLADE SOUTHAM

REXBURG, ID
NPI1588654628
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: ID  NP - 747A)
Enumeration Date2005-10-27
Last Update Date2007-10-01
Business Address
-- GLADE SOUTHAM NP
BYU - IDAHO 100 SHC
REXBURG, ID 83460-2010
Phone number: 208-496-1300
Mailing Address
-- GLADE SOUTHAM NP
BYU - IDAHO NURSING DEPARTMENT 117C CLARKE
REXBURG, ID 83460-0620
Phone number: 208-496-1385
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