Healthcare Provider Details

I. General information

NPI: 1013712330
Provider Name (Legal Business Name): IDAHO CONCIERGE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11696 W GABRIELLE CT # 83713
BOISE ID
83713-7812
US

IV. Provider business mailing address

11696 W GABRIELLE CT # 83713
BOISE ID
83713-7812
US

V. Phone/Fax

Practice location:
  • Phone: 208-314-1325
  • Fax:
Mailing address:
  • Phone: 208-314-1325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SABRINA BOJO
Title or Position: NURSE PRACTITIONER
Credential: AGNP-C
Phone: 208-314-1325