Healthcare Provider Details

I. General information

NPI: 1528757754
Provider Name (Legal Business Name): MADISON BLAKELY HELFRICH BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 S 6TH ST
BOISE ID
83702-7632
US

IV. Provider business mailing address

417 S 6TH ST
BOISE ID
83702-7632
US

V. Phone/Fax

Practice location:
  • Phone: 208-577-4460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number46652
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: