Healthcare Provider Details

I. General information

NPI: 1649840646
Provider Name (Legal Business Name): TAMARA M MCDONALD DNP, PMHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 S FEDERAL WAY STE 103-414
BOISE ID
83705-5204
US

IV. Provider business mailing address

3527 S FEDERAL WAY STE 103-414
BOISE ID
83705-5204
US

V. Phone/Fax

Practice location:
  • Phone: 208-918-4080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number57548
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: