Id Phs LLC

NPI #1245613967 in Boise, Idaho

Provider Information

NPI Number: 1245613967
Entity Type: Organization
Organization Name: Id Phs LLC
Primary Specialty: Nurse Practitioner
Enumeration Date: Jun 30, 2015
Last Updated: Jun 30, 2015

Practice Location

Address: 950 W. BANNCOCK STREET STE 1100
City: Boise
State: Idaho
ZIP Code: 83702-6140
Phone: (337) 991-9276

Authorized Official

Name: NICOLE HOWARD
Title: CEO
Phone: (337) 991-9276

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner - Family — Family	363LF0000X
Nurse Practitioner	363L00000X	Primary

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