Individual
SAMUEL HALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1346 CIMARRON CT, MIDDLETON, ID 83644-5894
(208) 695-8001
Mailing address
1346 CIMARRON CT, MIDDLETON, ID 83644-5894
(208) 695-8001
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
65699
ID
Other
Enumeration date
09/17/2020
Last updated
09/17/2020
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