Individual
MR. BRIAN P VANDENDRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
520 S EAGLE RD, SUITE 2213, MERIDIAN, ID 83642-6351
(208) 706-5447
(208) 706-5448
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 706-7500
(208) 706-7501
Taxonomy
Speciality
Code
Description
License number
State
363LX0106X
Occupational Health Nurse Practitioner
Primary
NP-637
ID
Other
Enumeration date
01/23/2007
Last updated
09/18/2012
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