| Doctor Name: | SUZANNE KEELE EDELMAN |
| NPI Number: | 1164628442 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP |
| License Number: | NP-325A |
| Business Practice Address: | 4702 W Cherry Creek Road Moore, ID - 83255 |
| Business Phone Number: | 2085542006 |
| Business Fax Number: | |
| Mailing Address: | 421 Memorial Dr, POCATELLO |
| State: | ID |
| Postal Code: | 832014008 |
| Phone Number: | 2085542006 |
| Fax Number: | |
| NPI Enumeration Date: | 06/25/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LC1500X |
| License Number: | NP-325A |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |