Healthcare Provider Details

I. General information

NPI: 1912199423
Provider Name (Legal Business Name): DALEEN ANN NELSON RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 WINTHROP WAY
BOISE ID
83709-0012
US

IV. Provider business mailing address

378 WINTHROP WAY
BOISE ID
83709-0012
US

V. Phone/Fax

Practice location:
  • Phone: 208-568-4900
  • Fax: 208-377-8118
Mailing address:
  • Phone: 208-568-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN24776
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number104 21342
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: