Individual
NICOLE L THURSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 E IDAHO ST, BOISE, ID 83712-6267
(208) 381-2711
(208) 323-9604
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
(208) 323-9604
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
M10117
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807932200
—
ID
Enumeration date
05/21/2007
Last updated
02/18/2014
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