| |
1226 W River St, Boise, ID 83702-7049 | |
(208) 331-1155 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Registered Nurse - Diabetes Educator |
Location | 1226 W River St, Boise, Idaho |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1003295452 | NPI | - | NPPES |
1003295452 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | 03 (Idaho) | Secondary |
163WD0400X | Registered Nurse - Diabetes Educator | 03 (Idaho) | Primary |
Mailing Address | Practice Location Address |
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190 E Bannock St, Boise, ID 83712-6241 Ph: (208) 381-2222 | 1226 W River St, Boise, ID 83702-7049 Ph: (208) 331-1155 |