Southam, Glade
Southam, Glade is an individual health care provider with primary practice located at Byu - Idaho 100 Shc, Rexburg ID 83460-2010. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Southam, Glade can be contacted via phone (208) 496-1300.Contact Information
Primary practice address
Byu - Idaho 100 Shc
Rexburg ID 83460-2010
Phone: (208) 496-1300
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | NP - 747A | Idaho |
Profile Details
| NPI number | 1588654628 |
|---|---|
| LBN Legal business name | Southam, Glade |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 27th, 2005 |
| Last updated | Oct 1st, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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