| NPI | 1790300598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETHANY VANCE CEO/Member 208-724-4125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 111N00000X Chiropractor |
| 225100000X Physical Therapist | |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2020-06-09 |