Individual
MARTY JO MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2020 W SPAULDING ST, BOISE, ID 83705-3551
(208) 721-2045
Mailing address
2020 W SPAULDING ST, BOISE, ID 83705-3551
(208) 721-2045
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZC248462K
DL
ID
Enumeration date
01/18/2021
Last updated
01/18/2021
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