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Doctors / ID
NURSE PRACTITIONER
Medical school: UNIVERSITY OF UTAH SCHOOL OF MEDICINE
Graduated: 2024
NPI: 1053159624
4650 HAWTHORNE RD, SUITE 3B
CHUBBUCK, ID 832022329
PO BOX, SUITE 2516
POCATELLO, ID 83206
Source: CMS National Downloadable File, September 2026.