Healthcare Provider Details

I. General information

NPI: 1487220380
Provider Name (Legal Business Name): TAMRA KATHERINE GERYK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 N GINZEL ST
BOISE ID
83703-4214
US

IV. Provider business mailing address

4280 N GINZEL ST
BOISE ID
83703-4214
US

V. Phone/Fax

Practice location:
  • Phone: 413-687-3027
  • Fax: 208-254-4895
Mailing address:
  • Phone: 307-690-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number55636
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: