Individual
PENNY REA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
5307 GREEN VALLEY PL, NAMPA, ID 83686-5790
(208) 899-7105
Mailing address
5307 GREEN VALLEY PL, NAMPA, ID 83686-5790
(208) 899-7105
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
55370
ID
Other
Enumeration date
03/13/2017
Last updated
03/13/2017
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