Healthcare Provider Details

I. General information

NPI: 1275456253
Provider Name (Legal Business Name): DANIELLE CREMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13477 W BLUEBONNET DR
BOISE ID
83713-1341
US

IV. Provider business mailing address

4015 W CASSIA ST
BOISE ID
83705-2114
US

V. Phone/Fax

Practice location:
  • Phone: 208-254-1112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8581525
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: