Organization
GARNET STATE ENTERPRISES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER GORDON GOURLEY ARNP (PSYCHIATRIC NURSE PRACTITIONER)
(208) 518-9927
Entity
Organization
Contact information
Practice address
2481 HALLEBERRY, HAYDEN, ID 83835-8339
(208) 518-9927
Mailing address
2481 HALLEBERRY, HAYDEN, ID 83835-8339
(208) 518-9927
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/06/2025
Last updated
01/06/2025
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