Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | NP-713A | ID |
NPI | 1073522082 |
---|---|
Provider Name | Melanie Ann Nash |
First Address | Boise, ID 83706-6001 |
Second Address | Boise, ID 83702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 08/07/2007 |