Healthcare Provider Details

I. General information

NPI: 1528874948
Provider Name (Legal Business Name): ASHLYN TUTYGRS HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 N MILWAUKEE ST STE A
BOISE ID
83704-7191
US

IV. Provider business mailing address

1740 N MILWAUKEE ST STE A
BOISE ID
83704-7191
US

V. Phone/Fax

Practice location:
  • Phone: 208-658-0238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1761071
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: