Organization
AMMARA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GAVIN FNP (OWNER)
(208) 263-1345
Entity
Organization
Contact information
Practice address
30410 HIGHWAY 200, PONDERAY, ID 83852-9601
(208) 263-1345
(208) 255-5531
Mailing address
30410 HIGHWAY 200, PONDERAY, ID 83852-9601
(208) 263-1345
(208) 255-5531
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-257A
ID
Other
Enumeration date
07/29/2006
Last updated
08/22/2020
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