Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | PA-2176 | ID |
NPI | 1033877527 |
---|---|
Provider Name | Mrs. Tiffany Kearny |
First Address | Boise, ID 83703-4253 |
Second Address | Boise, ID 83704-8707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2021 |
Last Update Date | 02/12/2021 |