Healthcare Provider Details

I. General information

NPI: 1538075577
Provider Name (Legal Business Name): AILIE DANIELS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 N LIBERTY ST STE 203
BOISE ID
83704-8708
US

IV. Provider business mailing address

5733 N PINERY CANYON AVE
MERIDIAN ID
83646-5808
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-5800
  • Fax:
Mailing address:
  • Phone: 206-200-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberN-39866
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: