| NPI | 1861035248 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MICHELLE SMITH Program Director 208-523-1130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2019-10-18 |
| Last Update Date | 2020-06-02 |