# GEM FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407919749
- **Authorized official:** MS. DEBORAH A CASDORPH FNP (FNP)
- **Authorized official phone:** (208) 365-3455

## Contact information

- **Practice address:** 1108 S WASHINGTON AVE, EMMETT, ID 83617-3535
- **Practice address phone:** (208) 365-3455
- **Practice address fax:** (208) 365-3422
- **Mailing address:** 1108 S WASHINGTON AVE, EMMETT, ID 83617-3535
- **Mailing address phone:** (208) 365-3455
- **Mailing address fax:** (208) 365-3422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | NP238A | ID | Yes |

## Other

- **Enumeration date:** 12/18/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010017986 | REGENCE BLUE SHIELD | ID |
| 01 | — | NP190 | BLUE CROSS | ID |