| NPI | 1982473799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA PIKE Admin 208-982-6734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2024-12-20 |