Individual
ELIZABETH BALLEWEG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2306 N 31ST ST, BOISE, ID 83703-5628
(406) 546-7469
Mailing address
2306 N 31ST ST, BOISE, ID 83703-5628
(406) 546-7469
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
63144
ID
Other
Enumeration date
12/09/2019
Last updated
12/09/2019
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