Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MRM-2036 | ID |
NPI | 1003499203 |
---|---|
Provider Name | Sarah A Hershman |
First Address | Boise, ID 83704-9251 |
Second Address | Boise, ID 83704-9251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2021 |
Last Update Date | 04/05/2021 |