Individual
MRS. MARIA LYNN TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
NP531A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP531A
STATE LICENSE #
ID
Enumeration date
07/02/2006
Last updated
09/19/2017
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