Individual
MRS. SARA JEAN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-BC
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-5015
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
55535
ID
363LG0600X
Gerontology Nurse Practitioner
55535
ID
Other
Enumeration date
04/25/2017
Last updated
08/08/2023
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