| NPI | 1720502370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHELLE JONES President 208-881-0902 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: ID NP-914A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID NP-914A) |
| 363LF0000X Nurse Practitioner Family (Licence: ID NP-914A) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: ID NP-914A) | |
| 363LW0102X Nurse Practitioner Women's Health (Licence: NP-914A) | |
| 363LX0001X Nurse Practitioner Obstetrics & Gynecology | |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2017-11-17 |