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Individual

MOLLY NICHOLS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
12080 W MCMILLAN RD, BOISE, ID 83713-2462
(208) 375-4955
(208) 375-5568
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
996162
ID
363A00000X
Physician Assistant
PA189595
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500756169
OR
Enumeration date
03/03/2017
Last updated
09/10/2024
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