Healthcare Provider Details

I. General information

NPI: 1972515054
Provider Name (Legal Business Name): HILARY ANN WARREN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N CURTIS RD SUITE 407
BOISE ID
83706-1336
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-4321
  • Fax: 208-367-4525
Mailing address:
  • Phone: 208-367-5170
  • Fax: 208-367-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTL-3799
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: