Healthcare Provider Details

I. General information

NPI: 1952235509
Provider Name (Legal Business Name): LEVANIA HABONIMANA ISACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S ORCHARD ST STE 110
BOISE ID
83705-1961
US

IV. Provider business mailing address

519 S GARDEN ST
BOISE ID
83705-1367
US

V. Phone/Fax

Practice location:
  • Phone: 208-918-4692
  • Fax:
Mailing address:
  • Phone: 208-605-0991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: