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Individual

MARY J STACKLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
8050 W NORTHVIEW ST, BOISE, ID 83704-7126
(208) 327-0504
Mailing address
8050 W NORTHVIEW ST, BOISE, ID 83704-7126
(208) 327-0504

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
NP-945A
ID

Other

Enumeration date
02/03/2010
Last updated
02/03/2010
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