Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | PA-1703 | ID |
NPI | 1083013056 |
---|---|
Provider Name | Andrea Metzler |
First Address | Boise, ID 83706-5042 |
Second Address | Boise, ID 83704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2014 |
Last Update Date | 27/08/2019 |