NPI 1417442484

Corbett Sousa

Organisation Point of Service Nampa, ID

Practice location

Address: 16 12th Ave S STE 208, Nampa, ID 83651-3937
Phone: (208) 649-6048
Fax: (208) 906-2343

Authorised official

Name: Katy Simmons
Title: Credentialing/Billing
Phone: (208) 452-6580

Registered specialties

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X Licence 37239 (ID)

Other Point of Service providers in Idaho →

Registry record

NPI: 1417442484
Entity type: Organization
NPI issued: 22 Jun 2018
Record last updated: 22 Jun 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.