Individual
DR. NICHOLE S HALVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
526 SHOUP AVE W STE F, TWIN FALLS, ID 83301-5050
(208) 736-7620
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 736-7620
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-9828
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164629887
—
ID
Enumeration date
06/27/2007
Last updated
03/11/2015
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