Healthcare Provider Details

I. General information

NPI: 1740851278
Provider Name (Legal Business Name): ADRIENNE OLNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 S AMERICANA BLVD STE 130
BOISE ID
83702-6754
US

IV. Provider business mailing address

247 N WHITEWATER PARK BLVD APT I304
BOISE ID
83702-5611
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-7530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberP17957
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: