Individual
MRS. KELLEY EILEEN GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(508) 864-0937
Mailing address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
101.0119709
VT
Other
Enumeration date
07/20/2016
Last updated
12/11/2018
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