Organization
RIVERSIDE PRIMARY CARE ADULT AND GERIATRIC MEDICINE PLLLP
Active
Organization
RIVERSIDE PRIMARY CARE ADULT AND GERIATRIC MEDICINE PLLLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA LONG NP (CO-OWNER)
(208) 850-1940
Entity
Organization
Contact information
Practice address
1673 W SHORELINE DR STE 100, BOISE, ID 83702-6749
(208) 593-3054
Mailing address
1673 W SHORELINE DR STE 100, BOISE, ID 83702-6749
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
09/13/2023
Last updated
09/13/2023
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