Individual
NICOLE STOLTZFUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1674 W HILL RD, BOISE, ID 83702-0958
(719) 930-3581
Mailing address
2458 N BOGUS BASIN RD, BOISE, ID 83702-0904
(719) 930-3581
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MASG-2331
ID
Other
Enumeration date
08/11/2014
Last updated
08/11/2014
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