Individual
MRS. CORTNEY A VANDENBURGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1450 AVIATION DR, SUITE 100, HAILEY, ID 83333-8785
(208) 788-3434
(208) 788-2025
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MR0827
ID
207Q00000X
Family Medicine Physician
Primary
O0419
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807191900
—
ID
01
—
P00721168
MCRR
ID
Enumeration date
06/21/2006
Last updated
02/21/2014
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