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Individual

NICOLE L. AMIDEO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
500 W. FORT ST., CLC, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Mailing address
500 W. FORT ST., CLC, BOISE, ID 83702
(208) 422-1000
(208) 422-1319

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-545
ID
363A00000X
Physician Assistant
PA545
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
807269700
ID
Enumeration date
06/26/2006
Last updated
03/23/2022
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