Individual
CODY JOHANNA BONINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
21 N FISHER PARK WAY, EAGLE, ID 83616-4796
(208) 996-8181
(208) 549-7880
Mailing address
13530 W HAZELNUT ST, BOISE, ID 83713-0870
(208) 608-9659
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
69928
ID
Other
Enumeration date
10/01/2021
Last updated
10/01/2021
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