Individual
MARY RENEE WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702
(208) 422-1000
Mailing address
4120 W MINERS FARM DR, BOISE, ID 83714-9314
(913) 219-4401
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
53-46306-042
KS
363LF0000X
Family Nurse Practitioner
53105
ID
Other
Enumeration date
02/06/2013
Last updated
04/19/2022
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