| NPI | 1790939056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON JENKINS Manager 208-529-7165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: ID 0-0424) |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2008-11-12 |