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Individual

STEPHANIE CIESLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PNP

Contact information

Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2074
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
59279
ID
363LP0200X
Pediatric Nurse Practitioner
R202541
MD
363LP0200X
Pediatric Nurse Practitioner
RN1021113
DC

Other

Enumeration date
09/18/2012
Last updated
07/11/2025
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