| NPI | 1922377027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE BENNION Owner 208-853-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 208D00000X General Practice |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2017-04-10 |