Individual
NICOLAS J. ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
703 S AMERICANA BLVD, STE 120, BOISE, ID 83702-5099
(208) 323-2600
Mailing address
190 E BANNOCK ST, BOISE, ID 83712
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA644
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010159170
BLUE SHIELD MERIDIAN
ID
01
—
000010159171
BLUE SHIELD BOISE
ID
01
—
PAD82
BLUE CROSS MERIDIAN
ID
Enumeration date
10/24/2006
Last updated
11/10/2012
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