Individual
MS. HEATHER ANN STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
4433 E SWITZER WAY, NAMPA, ID 83686-3014
(208) 871-3212
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
66533
ID
363LG0600X
Gerontology Nurse Practitioner
66533
ID
Other
Enumeration date
09/27/2017
Last updated
07/21/2022
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