Individual
MOLLY VAUGHAN PRENGAMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN, FNP-BC
Contact information
Practice address
2308 N COLE RD, SUITE H, BOISE, ID 83704-7361
(208) 375-8806
(208) 375-8826
Mailing address
2308 N COLE RD, SUITE H, BOISE, ID 83704-7361
(208) 375-8806
(208) 375-8826
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP443A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8050180
—
ID
Enumeration date
07/20/2007
Last updated
07/20/2007
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