Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | NP856A | ID |
NPI | 1003068677 |
---|---|
Provider Name | Nora M Suarez |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83712-6241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2008 |
Last Update Date | 23/02/2011 |