Individual
DUSTIN SHARPE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8050 W NORTHVIEW ST, BOISE, ID 83704-7126
(805) 327-0504
Mailing address
9251 W RIFLEMAN CT, BOISE, ID 83704-9737
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
32199
ID
Other
Enumeration date
10/17/2012
Last updated
10/17/2012
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