Individual
TAMARA FREDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8169 W VICTORY RD, BOISE, ID 83709-4164
(208) 854-4173
(208) 854-4012
Mailing address
8169 W VICTORY RD, BOISE, ID 83709-4164
(208) 854-4173
(208) 854-4012
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-319A
ID
Other
Enumeration date
02/05/2010
Last updated
02/05/2010
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