Organization Name: | AMMARA, INC. |
NPI Number: | 1821003708 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KATHY GAVIN (OWNER) |
Mailing Address: | 30410 Highway 200 Ponderay |
State: | ID US |
Postal Code: | 838529601 |
Phone Number: | 2082631345 |
Fax Number: | 2082555531 |
NPI Enumeration Date: | 07/29/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | NP-257A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |