Organization
MOUNTAIN STATES ONCOLOGY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONI SULLIVAN (BUSINESS ADMINISTRATOR)
(208) 343-3223
Entity
Organization
Contact information
Practice address
210 W JEFFERSON ST, BOISE, ID 83702-6044
(208) 343-3223
(208) 343-3263
Mailing address
PO BOX 1809, BOISE, ID 83701-1809
(208) 343-3223
(208) 343-3263
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/21/2008
Last updated
05/21/2008
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