Individual
ALICIA BATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
STUDENT NP
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7971038
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/18/2024
Last updated
12/17/2024
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