Individual
MARY S RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6140 W CURTISIAN AVE, STE 200, BOISE, ID 83704-8880
(208) 302-0000
(208) 302-0055
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-0000
(208) 302-0055
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-1157A
ID
Other
Enumeration date
08/16/2012
Last updated
11/30/2016
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