Individual
MRS. MARY AMANDA BASHISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RRT
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4598
(208) 422-1420
(208) 422-1293
Mailing address
500 W FORT ST, BOISE, ID 83702-4598
(208) 422-1420
(208) 422-1293
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
Primary
LRT-914
ID
Other
Enumeration date
11/14/2022
Last updated
11/14/2022
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