Mmmedical Group Llc.

NPI #1548890460 in Boise, Idaho

Provider Information

NPI Number: 1548890460
Entity Type: Organization
Organization Name: Mmmedical Group Llc.
Primary Specialty: Nurse Practitioner
Enumeration Date: Jan 20, 2020
Last Updated: Sep 23, 2020

Practice Location

Address: 801 N STILSON RD STE 300
City: Boise
State: Idaho
ZIP Code: 83703-5145
Phone: (208) 332-4540

Authorized Official

Name: RANDY EVARO
Title: PRESIDENT
Phone: (208) 333-0000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner	363L00000X	Primary

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