Individual
DINA LIN MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6933 W EMERALD ST, BOISE, ID 83704-8616
(858) 207-8790
Mailing address
330 W ANTON DR, MERIDIAN, ID 83646-2066
(858) 207-8861
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
63001
ID
Other
Enumeration date
02/03/2021
Last updated
02/03/2021
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