NPI | 1891820767 |
---|---|
Entity Type | Organization |
Authorized Contact | CHERI PETERSON Credentialer 208-954-5594 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology |
363A00000X Physician Assistant | |
363AM0700X Physician Assistant, Medical | |
363LF0000X Nurse Practitioner, Family | |
363LP0808X Nurse Practitioner, Psych/Mental Health | |
Enumeration Date | 2007-02-22 |
Last Update Date | 2021-04-20 |