Healthcare Provider Details

I. General information

NPI: 1184565673
Provider Name (Legal Business Name): NANCY LOURDES DE CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8675 W ARDENE ST
BOISE ID
83709-2601
US

IV. Provider business mailing address

11518 W GABRIELLE DR
BOISE ID
83713-7881
US

V. Phone/Fax

Practice location:
  • Phone: 208-780-3900
  • Fax: 208-375-2882
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: