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Individual

TONY BASTAR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
58 W CHRISFIELD DR, MERIDIAN, ID 83646-3255
(208) 419-5300
Mailing address
58 W CHRISFIELD DR, MERIDIAN, ID 83646-3255
(208) 419-5300

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
56825
ID

Other

Enumeration date
04/11/2023
Last updated
04/12/2023
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