| NPI | 1669682381 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA FAYE BETHEL Member 208-375-8806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP524A) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-08-22 |