| NPI | 1902497795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN L WALKER Chief Clinical Officer 208-305-6131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 163W00000X Registered Nurse | |
| 207R00000X Internal Medicine | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2021-05-19 |