Healthcare Provider Details

I. General information

NPI: 1174245591
Provider Name (Legal Business Name): DORI A HEALEY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12404 W VIEW RIDGE DR
BOISE ID
83709-0009
US

IV. Provider business mailing address

12404 W VIEW RIDGE DR
BOISE ID
83709-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-550-1097
  • Fax:
Mailing address:
  • Phone: 208-550-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number69240
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: