Individual
ANDREW TIETJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
6051 W EMERALD ST, BOISE, ID 83704-8969
(208) 302-5150
(208) 302-5155
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5871656
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/20/2025
Last updated
05/23/2025
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