| NPI | 1881144780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAKAYLA RUNYAN Vice President 208-887-6810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID NP-1345A) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2016-10-04 |