Individual
NARI HSIU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
500 W FORT ST BLDG 116, BOISE, ID 83702-4501
(208) 422-1163
Mailing address
1959 NE PACIFIC ST BOX 356560, SEATTLE, WA 98195-6560
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
O-1509
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2017
Last updated
10/19/2021
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