Individual
SUSAN MCMULLEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8950 W EMERALD STE 168, BOISE, ID 83704
(208) 323-6273
(208) 323-6277
Mailing address
8950 W EMERALD STE 168, BOISE, ID 83704
(208) 323-6273
(208) 323-6277
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP715A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010152154
BLUE SHIELD
ID
01
—
NPXB9
BLUE CROSS
ID
Enumeration date
04/01/2006
Last updated
07/08/2007
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