Individual
DR. NICOLE MARIE MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NMD
Contact information
Practice address
4219 W EMERALD ST, BOISE, ID 83706-2036
(208) 338-0405
(208) 422-9957
Mailing address
4219 W EMERALD ST, BOISE, ID 83706-2036
(208) 338-0405
(208) 422-9957
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
NT00001153
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201450836
TAX IDENTIFICATION NUMBER
WA
Enumeration date
12/04/2006
Last updated
01/28/2020
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