Individual
NICOLE LAINE MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12553 W EXPLORER DR STE 190, BOISE, ID 83713-1612
(208) 972-5254
Mailing address
12553 W EXPLORER DR STE 190, BOISE, ID 83713-1612
(208) 972-5254
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/01/2020
Last updated
07/01/2020
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