Individual
TINA MONIQUE BOSSOLONO-WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1510 12TH AVE RD STE 200, NAMPA, ID 83686-6946
(208) 302-6800
(208) 302-6855
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 236-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
40406
ID
Other
Enumeration date
11/23/2018
Last updated
09/30/2024
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