Individual
MEGHANN R BOSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
13099 W PAINT DR, BOISE, ID 83713-1927
(208) 724-2599
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-1001A
ID
Other
Enumeration date
08/23/2010
Last updated
12/27/2012
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