Healthcare Provider Details

I. General information

NPI: 1619230844
Provider Name (Legal Business Name): ERIN MARISSA WELCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N CURTIS ROAD
BOISE ID
83706
US

IV. Provider business mailing address

PO BOX 190930
BOISE ID
83719-0930
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-4343
  • Fax: 208-367-7667
Mailing address:
  • Phone: 208-367-5170
  • Fax: 208-367-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53167
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: