Individual
BRYCE CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
450 E MAIN ST, REXBURG, ID 83440
(208) 359-6900
Mailing address
450 E MAIN ST, REXBURG, ID 83440-2048
(208) 359-6900
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-1475A
ID
Other
Enumeration date
08/14/2014
Last updated
08/14/2014
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