Individual
RACHEL ELLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
305 E JEFFERSON ST, BOISE, ID 83712-6231
(208) 381-6196
(208) 381-6199
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
55305
ID
Other
Enumeration date
09/09/2022
Last updated
10/26/2022
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