Individual
AUTUMN ROSE MASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8748
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
45530
ID
363LA2100X
Acute Care Nurse Practitioner
Primary
71748
ID
Other
Enumeration date
12/30/2021
Last updated
02/22/2022
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