Healthcare Provider Details

I. General information

NPI: 1982382164
Provider Name (Legal Business Name): ANA ROSA CARRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 N BENJAMIN LN STE 185
BOISE ID
83704-9625
US

IV. Provider business mailing address

545 N BENJAMIN LN STE 185
BOISE ID
83704-9625
US

V. Phone/Fax

Practice location:
  • Phone: 208-322-1026
  • Fax:
Mailing address:
  • Phone: 208-871-7091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44152
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number63389
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: