Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 31630 | ID |
NPI | 1104318690 |
---|---|
Provider Name | Janice Preuit |
First Address | Twin Falls, ID 83301-7868 |
Second Address | Twin Falls, ID 83301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2018 |
Last Update Date | 10/07/2018 |