| NPI | 1942699715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARAMIE LINNING WHEELER Owner 208-589-3846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID o-0426) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID NP676A) |
| Enumeration Date | 2015-01-17 |
| Last Update Date | 2015-01-17 |