Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | M-4612 | ID |
NPI | 1326435850 |
---|---|
Provider Name | Cynthis Sandlin |
First Address | Boise, ID 83709-2505 |
Second Address | Boise, ID 83709-2505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2015 |
Last Update Date | 22/04/2015 |