Individual
JILL MOUGHAMIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4700 N CLOVERDALE RD STE 103, BOISE, ID 83713-1067
(208) 392-8383
Mailing address
2965 E TARPON DR STE 150, MERIDIAN, ID 83642-9007
(208) 287-9420
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
NP-1708A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP-1708A
STATE LICENSE
ID
Enumeration date
04/01/2016
Last updated
04/01/2016
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