Healthcare Provider Details

I. General information

NPI: 1700797099
Provider Name (Legal Business Name): CHRISTINE MICHELLE TAYLOR PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7731 N FROMAN AVE
BOISE ID
83714-5513
US

IV. Provider business mailing address

7731 N FROMAN AVE
BOISE ID
83714-5513
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9181936
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: