Organization
FAMILY MEDICINE & MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANETTE FORD P.A.-C (PRESIDENT)
(208) 725-0900
Entity
Organization
Contact information
Practice address
380 WASHINGTON AVE, SUITE 204, KETCHUM, ID 83340-1575
(208) 725-0900
(208) 725-0901
Mailing address
PO BOX 1575, KETCHUM, ID 83340-1575
(208) 725-0900
(208) 725-0901
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-126
ID
Other
Enumeration date
05/20/2014
Last updated
05/20/2014
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