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A physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Gynecology |
207VG0400X | 16 | Physician/Obstetrics & Gynecology |
| NPI Number | 1760884324 |
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| LBN Legal business name | PPGNW - IDAHO | ||||
| Authorized official | MARY WENDT - (REVENUE CYCLE DIRECTOR) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 09/25/2014 | ||||
| Last updated | 09/25/2014 - About 12 years ago | ||||
| Identifiers |
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PPGNW - IDAHO
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PPGNW - IDAHO