Individual
STACI JAE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP-BC
Contact information
Practice address
100 E IDAHO ST STE 302, BOISE, ID 83712-6269
(208) 343-7501
(208) 336-8248
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
5961472
ID
Other
Enumeration date
10/31/2024
Last updated
11/12/2024
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