Individual
MR. STEPHEN DOUGLAS MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C, PMHNP-BC
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
55498
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
55498
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP60919662
WA
Other
Enumeration date
04/27/2017
Last updated
11/25/2022
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