Organization
EVERGREEN PHYSICAL MEDICINE, LLC
Active
Other names
Evergreen Physical Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
SUMMER DANCE (EXECUTIVE DIRECTOR)
(208) 895-8595
Entity
Organization
Contact information
Practice address
1710 W CHERRY LN, MERIDIAN, ID 83642-1340
(208) 895-8595
Mailing address
1710 W CHERRY LN, MERIDIAN, ID 83642-1340
(208) 895-8595
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/06/2018
Last updated
02/06/2018
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