| NPI | 1912378787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBAN HATCH Manager 208-200-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: ID M4260) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID NP 1389A) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2015-10-19 |