Individual
LAURA L TIRRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1880 JUDITH LN, BOISE, ID 83705-3185
(208) 367-6910
(208) 367-6170
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5189
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M5784
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003977200
—
ID
Enumeration date
06/09/2006
Last updated
02/29/2012
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