Individual
DR. RALENE WIBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
211 16TH AVE N, NAMPA, ID 83687-4058
(208) 461-7149
(208) 467-3391
Mailing address
211 16TH AVE N, PO BOX 9, NAMPA, ID 83687-4058
(208) 461-7149
(208) 467-3391
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101252362
VA
207Q00000X
Family Medicine Physician
Primary
M-12117
ID
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
NP464A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP464A
NP LICENSE
ID
Enumeration date
05/08/2006
Last updated
08/01/2013
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