Individual
TIMOTHY CARTER FORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5288 N SAMSON AVE, BOISE, ID 83704-1971
(208) 724-1597
Mailing address
5288 N SAMSON AVE, BOISE, ID 83704-1971
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN6771841
ID
Other
Enumeration date
05/15/2026
Last updated
05/15/2026
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