Individual
NANCY GREENWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 ROBBINS RD, #300, BOISE, ID 83702-4565
(208) 489-4016
(208) 489-5188
Mailing address
600 ROBBINS RD, #300, BOISE, ID 83702-4565
(208) 489-4016
(208) 489-5188
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
M7342
ID
208100000X
Physical Medicine & Rehabilitation Physician
MD21541
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831175819
—
ID
01
—
M7342
STATE LICENSE
ID
Enumeration date
12/21/2005
Last updated
02/20/2013
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