Individual
REATTA OMOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2550 ADDISON AVE E STE E, TWIN FALLS, ID 83301-6748
(208) 814-7780
(208) 814-7746
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9861160
ID
Other
Enumeration date
06/20/2024
Last updated
09/09/2024
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