Individual
GAYLE MATSUMURO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
413 N ALLUMBAUGH ST STE 101, BOISE, ID 83704-9219
(208) 323-1125
(208) 323-1905
Mailing address
413 N ALLUMBAUGH ST STE 101, BOISE, ID 83704-9219
(208) 323-1125
(208) 323-1905
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
26983
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
64061
ID
Other
Enumeration date
02/12/2020
Last updated
04/24/2020
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