Individual
MATTHEW HARGIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1032 S BRIDGEWAY PL, EAGLE, ID 83616-6099
(208) 246-0123
Mailing address
PO BOX 4302, BOISE, ID 83711-4302
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4971843
ID
Other
Enumeration date
01/23/2025
Last updated
02/27/2025
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