Individual
KATHERINE HAWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-5500
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
73564
ID
363LA2100X
Acute Care Nurse Practitioner
73564
ID
Other
Enumeration date
07/18/2022
Last updated
12/08/2022
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