Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | M7563 | ID |
NPI | 1093791972 |
---|---|
Provider Name | Barbara E Quattrone |
First Address | Boise, ID 83702-4565 |
Second Address | Meridian, ID 83642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 18/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G83305 | (02) | ID |