Individual
MARK THOMAS PYBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
867 S VANGUARD WAY, MERIDIAN, ID 83642-7552
(208) 302-7950
(208) 302-7955
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
74921
ID
Other
Enumeration date
01/05/2023
Last updated
09/17/2024
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