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Organization
ASTHMA & ALLERGY OF IDAHO
Active
Organization
ASTHMA & ALLERGY OF IDAHO
Active
Other names
Asthma & Allergy of Idaho mid level group
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW WICKERN (CREDENTIALING SPECIALIST)
(208) 734-6091
Entity
Organization
Contact information
Practice address
1502 LOCUST ST N STE 600, TWIN FALLS, ID 83301-4164
(208) 734-6091
(208) 734-4654
Mailing address
1502 LOCUST ST N STE 600, TWIN FALLS, ID 83301-4164
(208) 734-6091
(208) 734-4654
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/07/2007
Last updated
01/14/2021
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