Individual
MARIAH OLLIVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6165 W EMERALD ST, BOISE, ID 83704-8613
(208) 302-3900
(208) 302-3955
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 302-9342
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1871560
ID
363A00000X
Physician Assistant
—
—
Other
Enumeration date
08/04/2023
Last updated
09/03/2025
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