Individual
STACY MARIE HACKENMILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
100 E IDAHO ST STE 400, BOISE, ID 83712-6267
(208) 381-4171
(208) 381-4172
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
447128
ID
Other
Enumeration date
10/28/2025
Last updated
11/17/2025
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