Individual
DELORES MAYBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
5601 W CHINDEN BLVD, GARDEN CITY, ID 83714-1463
(208) 809-2865
(208) 809-2866
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
56562
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56562
APRN LICENSE
ID
Enumeration date
08/25/2017
Last updated
08/25/2021
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