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Individual
WILLIAM MARK IMUS JR.
Active
Individual
WILLIAM MARK IMUS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP57A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010152061
REGENCE BLUE SHIELD
ID
05
—
804251600
—
ID
01
—
NPWD6
BLUE CROSS OF IDAHO
ID
Enumeration date
07/04/2006
Last updated
07/08/2009
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