Individual
CARLIE MANCINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1075 E PARK BLVD, BOISE, ID 83712-7722
(208) 381-5970
Mailing address
1075 E PARK BLVD, BOISE, ID 83712-7722
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
10012906
OR
163W00000X
Registered Nurse
N-39732
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
54425
ID
Other
Enumeration date
05/16/2016
Last updated
11/03/2023
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