Organization
A2C CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY HUMPHERYS (PRACTICE MANAGER)
(208) 252-5621
Entity
Organization
Contact information
Practice address
333 W CEDAR ST STE 3, POCATELLO, ID 83201-5045
(208) 252-5621
(208) 648-4167
Mailing address
333 W CEDAR ST STE 3, POCATELLO, ID 83201-5045
(208) 252-5621
(208) 648-4167
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/17/2021
Last updated
02/17/2021
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