BEVERLEY ANN BLAKE ODOHERTY

TWIN FALLS, ID
NPI1821166539
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: ID  NP925A)
Additional Taxonomies363L00000X Nurse Practitioner
(Licence: CO  RN172038)
Enumeration Date2006-12-01
Last Update Date2024-09-09
Business Address
Mrs. BEVERLEY ANN BLAKE ODOHERTY CFNP
801 POLE LINE RD W
TWIN FALLS, ID 83301-5810
Phone number: 208-814-4100
Mailing Address
Mrs. BEVERLEY ANN BLAKE ODOHERTY CFNP
190 E BANNOCK ST
BOISE, ID 83712-6241
Phone number: 208-381-8752