Individual
GLADE SOUTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
BYU - IDAHO, 100 SHC, REXBURG, ID 83460-2010
(208) 496-1300
Mailing address
BYU - IDAHO NURSING DEPARTMENT, 117C CLARKE, REXBURG, ID 83460-0620
(208) 496-1385
(208) 496-5386
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP - 747A
ID
Other
Enumeration date
10/27/2005
Last updated
10/01/2007
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