Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 5142 | ID |
NPI | 1053836361 |
---|---|
Provider Name | Amber Valene Hawker |
First Address | Blackfoot, ID 83221-1751 |
Second Address | Blackfoot, ID 83221-1751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2017 |
Last Update Date | 17/03/2018 |