Healthcare Provider Details

I. General information

NPI: 1477181543
Provider Name (Legal Business Name): KERRIANN BOANCA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRIANN FINNEGAN MD

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N ROBBINS RD STE 100
BOISE ID
83702-4539
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-1615
  • Fax: 208-381-5141
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number3271773
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD210011692
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPG205706
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: