Graduated: 2021
NPI: 1932953288
Practice Locations (2)
PORTNEUF VALLEY FAMILY CENTER
444 HOSPITAL WAY, SUITE 477
POCATELLO, ID 832012744
2082337832
845 W CTR ST, SUITE L200
POCATELLO, ID 832044205
2089438838
Source: CMS National Downloadable File, September 2026.