Organization
OLDE TOWN MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN E TOMEY NP (PROVIDER/OWNER)
(208) 888-5422
Entity
Organization
Contact information
Practice address
124 E PINE AVE, MERIDIAN, ID 83642-2331
(208) 887-5422
(208) 888-6297
Mailing address
124 E PINE AVE, MERIDIAN, ID 83642-2331
(208) 887-5422
(208) 888-6297
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP-735A
IDAHO NP LICENSE
ID
Enumeration date
02/29/2016
Last updated
03/11/2016
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