Healthcare Provider Details

I. General information

NPI: 1003461245
Provider Name (Legal Business Name): AMY STENHOUSE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N 1ST ST STE 150
BOISE ID
83702-6135
US

IV. Provider business mailing address

255 N WHITEWATER PARK BLVD APT P103
BOISE ID
83702-5672
US

V. Phone/Fax

Practice location:
  • Phone: 333-115-0837
  • Fax:
Mailing address:
  • Phone: 605-595-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGENP-162
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: