Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 00251176S | ID |
NPI | 1063591287 |
---|---|
Provider Name | Donna J Amyx |
First Address | Boise, ID 83709 |
Second Address | Boise, ID 83709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |