Individual
MITZI M CIESLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 E IDAHO ST, STE 200, BOISE, ID 83712-6267
(208) 381-7360
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
N25439
ID
Other
Enumeration date
02/23/2013
Last updated
02/23/2013
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