person
Glade Southam, NP
Family Nurse Practitioner in Rexburg, Idaho
NPI 1588654628

Glade Southam is a Family Nurse Practitioner based in Rexburg, ID and is specialized in Family. Glade Southam practices in Rexburg, ID and has the professional credentials of NP. The NPI Number for Glade Southam is 1588654628 and holds a License No. NP - 747A (Idaho).

The current practice location address for Glade Southam is Byu - Idaho, Rexburg, ID and can be reached out via phone at 208-496-1300.

Location: Byu - Idaho, Rexburg, ID, 83460-0620
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Provider Profile Details
NPI Number
1588654628
Provider Name
Glade Southam
Credential
NP
Provider Entity Type
Individual
Gender
Male
Address
Byu - Idaho, Rexburg, ID, 83460-0620
Phone Number
208-496-1300
Fax Number
Provider Enumeration Date
10/27/2005
Last Update Date
03/08/2024
institution
Provider Business Practice Location Address Details
Address
Byu - Idaho
City
State
Zip
83460-2010
Phone Number
208-496-1300
Fax Number
person
Provider Business Mailing Address Details
Address
Byu - Idaho
City
State
Zip
83460-2010
Phone Number
208-496-1300
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
License No.
NP - 747A (Idaho)
Definition
Definition to come...
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