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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