Healthcare Provider Details

I. General information

NPI: 1871370544
Provider Name (Legal Business Name): MICHELLE ASHLEY DOBSON CSFA, CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N ROBBINS RD STE 400
BOISE ID
83702-4566
US

IV. Provider business mailing address

600 N ROBBINS RD STE 400
BOISE ID
83702-4566
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-2663
  • Fax:
Mailing address:
  • Phone: 208-706-2663
  • Fax: 208-489-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number195801
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: