Individual
BRANDON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
5067 CAMDEN ST, CHUBBUCK, ID 83202-3501
(208) 840-0044
Mailing address
5067 CAMDEN ST, CHUBBUCK, ID 83202-3501
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
65705
ID
Other
Enumeration date
09/16/2020
Last updated
09/16/2020
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