Healthcare Provider Details

I. General information

NPI: 1285424432
Provider Name (Legal Business Name): ALYSSA COLE CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2025
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD
MERIDIAN ID
83642-6351
US

IV. Provider business mailing address

4351 E BURGUNDY DR
NAMPA ID
83686-5078
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-2161
  • Fax:
Mailing address:
  • Phone: 208-713-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number109210
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: