| NPI | 1790846392 |
|---|---|
| Other Name | MID LEVEL PRACTITIONER GROUP |
| Entity Type | Organization |
| Authorized Contact | KAREN J KELLIE President Administrator 208-634-2221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID 11) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |