Individual
KEVIN O'DONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2619 W FAIRVIEW AVE STE 2100, BOISE, ID 83702-6722
(208) 706-2663
(208) 489-4300
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
59222
ID
Other
Enumeration date
01/26/2024
Last updated
02/22/2024
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