| NPI | 1992578413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTELL WILLIAMS Chief Administrative Officer 208-630-4087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-11-06 |