Individual
THIAGO ALBERTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
11197 W FAIRVIEW AVE, BOISE, ID 83713-7935
(208) 378-8011
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
62877
ID
Other
Enumeration date
10/16/2019
Last updated
07/13/2021
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