Individual
TYLER JUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
645 E 5TH ST, WEISER, ID 83672-2202
(208) 549-0370
(208) 302-0855
Mailing address
645 E 5TH ST, WEISER, ID 83672-2202
(208) 302-0855
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
55104
ID
363LG0600X
Gerontology Nurse Practitioner
Primary
55104
ID
Other
Enumeration date
03/29/2017
Last updated
02/05/2024
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