Individual
SUSAN SANSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
360 E MONTVUE DR STE 100, MERIDIAN, ID 83642-6318
(208) 855-2900
(208) 855-2911
Mailing address
360 E MONTVUE DR STE 100, MERIDIAN, ID 83642-6318
(208) 855-2900
(208) 855-2911
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
54528
ID
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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