Individual
VIDA VRECA-PONNEQUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
207 1ST ST S, NAMPA, ID 83651-3703
(208) 466-7869
(208) 466-5359
Mailing address
PO BOX 9, NAMPA, ID 83653-0009
(208) 467-4431
(208) 466-5359
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
64975
ID
363LF0000X
Family Nurse Practitioner
95002571
CA
Other
Enumeration date
08/21/2015
Last updated
07/10/2025
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