Individual
GEORGETTA OKUMAGBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
9492 W FAIRVIEW AVE, BOISE, ID 83704-8101
(208) 284-7100
Mailing address
9492 W FAIRVIEW AVE, BOISE, ID 83704-8101
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
5771468
ID
2084P0804X
Child & Adolescent Psychiatry Physician
5771468
ID
2084P0805X
Geriatric Psychiatry Physician
5771468
ID
Other
Enumeration date
08/28/2025
Last updated
08/28/2025
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