Healthcare Provider Details

I. General information

NPI: 1326961194
Provider Name (Legal Business Name): AMANDA JEAN TAPANGCO RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N LIBERTY ST STE 204
BOISE ID
83704-8707
US

IV. Provider business mailing address

567 N PRINGLEWOOD PL
STAR ID
83669-5838
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-4063
  • Fax:
Mailing address:
  • Phone: 208-367-4063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number47963
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: