| NPI | 1942064522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIK RICHARDSON Owner / Do 208-593-6393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2024-02-13 |
| Last Update Date | 2024-04-08 |