Healthcare Provider Details

I. General information

NPI: 1093633323
Provider Name (Legal Business Name): SIERRA RALPHS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W MAIN ST STE 100
BOISE ID
83702-7261
US

IV. Provider business mailing address

2411 E RIVERSIDE DR APT O205
EAGLE ID
83616-7569
US

V. Phone/Fax

Practice location:
  • Phone: 208-342-7400
  • Fax:
Mailing address:
  • Phone: 208-403-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07260237
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: