Individual
OLIVIA SOUTHARD MAYFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Contact information
Practice address
3015 E MAGIC VIEW DR STE 130, MERIDIAN, ID 83642-3750
(208) 482-5567
(208) 482-5515
Mailing address
3843 W RIVA CAPRI ST, MERIDIAN, ID 83646-6739
(520) 488-8568
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
74554
ID
Other
Enumeration date
12/28/2022
Last updated
12/28/2022
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