Individual
ELENA VM SPEROFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
500 W FORT ST, # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1591
Mailing address
500 W FORT ST, # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1591
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4753
CT
363LA2200X
Adult Health Nurse Practitioner
Primary
NP-1430A
ID
Other
Enumeration date
09/21/2011
Last updated
03/04/2022
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