Organization
EDGE MEDICAL LLC
Active
Other names
Initial Point Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN NIELSEN PA-C (OWNER)
(208) 884-0835
Entity
Organization
Contact information
Practice address
2640 S EAGLE RD, MERIDIAN, ID 83642-6704
(208) 884-0835
(208) 884-4794
Mailing address
2640 S EAGLE RD, MERIDIAN, ID 83642-6704
(208) 884-0835
(208) 884-4794
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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