Individual
NICHOLE BLAIR SHUMWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1308 8TH ST, RUPERT, ID 83350-1530
(208) 436-4322
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
O-1848
ID
Other
Enumeration date
04/15/2020
Last updated
06/05/2025
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