Healthcare Provider Details

I. General information

NPI: 1003673468
Provider Name (Legal Business Name): TRINA S HUNTER RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRINA S BOWLES RN, IBCLC

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 W EMERALD ST STE 160
BOISE ID
83704-8297
US

IV. Provider business mailing address

8601 W EMERALD ST STE 160
BOISE ID
83704-8297
US

V. Phone/Fax

Practice location:
  • Phone: 208-991-4488
  • Fax:
Mailing address:
  • Phone: 208-991-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-88978
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: