| NPI | 1770129322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILLIESUE MAYO Owner/Np 208-318-1619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2019-11-19 |
| Last Update Date | 2023-09-06 |