State of Idaho

NPI #1265558019 in Nampa, Idaho

Provider Information

NPI Number: 1265558019
Entity Type: Organization
Organization Name: State of Idaho
Primary Specialty: Family Medicine
Enumeration Date: Mar 22, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 1660 11TH AVE N
City: Nampa
State: Idaho
ZIP Code: 83687-5000
Phone: (208) 442-2812

Authorized Official

Name: SUE BROETJE
Title: ADMINISTRATIVE DIRECTOR
Phone: (208) 442-2812

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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