Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | NP1323A | ID |
NPI | 1073952016 |
---|---|
Provider Name | Hannah Elisabeth Underdahl |
First Address | Boise, ID 83704-9251 |
Second Address | Boise, ID 83712-6322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2013 |
Last Update Date | 31/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073952016 | (05) | ID |