Individual
EDITH MARY ROE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-BC
Contact information
Practice address
126 W IDAHO AVE, HOMEDALE, ID 83628-0037
(208) 337-7038
Mailing address
126 W. IDAHO AVE, HOMEDALE, ID 83628
(208) 337-7038
(208) 337-4652
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201910193NP
OR
363LA2200X
Adult Health Nurse Practitioner
Primary
60044
ID
Other
Enumeration date
11/13/2018
Last updated
04/21/2020
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