Healthcare Provider Details

I. General information

NPI: 1932727823
Provider Name (Legal Business Name): GABRIELLE I DYMENT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GABRIELLE TRENGA NP

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 N COLE RD
BOISE ID
83704-8537
US

IV. Provider business mailing address

PO BOX 191050
BOISE ID
83719-1050
US

V. Phone/Fax

Practice location:
  • Phone: 208-809-2880
  • Fax: 208-809-2881
Mailing address:
  • Phone: 208-955-6500
  • Fax: 208-955-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number54902
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number54902
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: