| NPI | 1992325815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER MICHAEL KOLOBOW Nurse Practitioner 208-267-2255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2026-01-15 |