Individual
ROSE M STILES JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1304 1/2 S OWYHEE ST, BOISE, ID 83705-6011
(208) 384-0141
Mailing address
1304 1/2 S OWYHEE ST, BOISE, ID 83705-6011
(208) 384-0141
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
40517
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807816600
—
ID
Enumeration date
06/15/2008
Last updated
06/15/2008
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