| 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 |