Organization
BOISE STATE UNIVERSITY
Active
Other names
Boise State University Clinical Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE HUDON PHD (CLINICAL LAB MANAGER)
(208) 995-3765
Entity
Organization
Contact information
Practice address
2133 W CESAR CHAVEZ LN RM 239, BOISE, ID 83725-0001
(208) 426-1038
Mailing address
1910 UNIVERSITY DR # MS 1515, BOISE, ID 83725-0002
(208) 426-1038
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
10/27/2020
Last updated
10/12/2023
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