Individual
AMANDA MARIE TILLEMANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
13500 S PLEASANT VALLEY RD, KUNA, ID 83634-2709
(208) 336-0740
Mailing address
3540 S BEVERLY ST, BOISE, ID 83709-4907
(775) 247-7624
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
68559
ID
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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