Individual
IRENE PUCCIARELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
701 E PARKCENTER BLVD, BOISE, ID 83706-6528
(208) 381-6400
(208) 381-6450
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
O0633
ID
207R00000X
Internal Medicine Physician
OS012839
PA
Other
Enumeration date
04/26/2006
Last updated
09/15/2012
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