institution
Olde Town Medical
Adult Health Nurse Practitioner in Meridian, Idaho
NPI 1245690544

Olde Town Medical is an Adult Health Nurse Practitioner based in Meridian, ID and is specialized in Adult Health. Olde Town Medical practices in Meridian, ID. The NPI Number for Olde Town Medical is 1245690544 and holds a License No. (Idaho).

The current practice location address for Olde Town Medical is 124 E Pine Ave, Meridian, ID and can be reached out via phone at 208-887-5422 and via fax at 208-888-6297.

Location: 124 E Pine Ave, Meridian, ID, 83642-2331
institution
Provider Profile Details
NPI Number
1245690544
Provider Name
Olde Town Medical
Credential
Provider Entity Type
Organization
Address
124 E Pine Ave, Meridian, ID, 83642-2331
Phone Number
208-887-5422
Fax Number
208-888-6297
Provider Enumeration Date
02/29/2016
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
NP-735A 01 ID IDAHO NP LICENSE
institution
Provider Business Practice Location Address Details
Address
124 E Pine Ave
City
State
Zip
83642-2331
Phone Number
208-887-5422
Fax Number
208-888-6297
person
Provider Business Mailing Address Details
Address
124 E Pine Ave
City
State
Zip
83642-2331
Phone Number
208-887-5422
Fax Number
208-888-6297
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Adult Health
Taxonomy
License No.
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Definition
Definition to come...
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