Individual
NICOLE RANDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
6051 W EMERALD ST, BOISE, ID 83704-8969
(208) 302-5100
(208) 302-5155
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 302-9342
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-1911
ID
207Q00000X
Family Medicine Physician
R-12232
IA
Other
Enumeration date
06/15/2021
Last updated
07/09/2024
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