Healthcare Provider Details

I. General information

NPI: 1750200895
Provider Name (Legal Business Name): ANGELIA MARIE SILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 11TH AVE S STE 125
NAMPA ID
83651-3945
US

IV. Provider business mailing address

11902 BONNIE LN
NAMPA ID
83651-8003
US

V. Phone/Fax

Practice location:
  • Phone: 208-919-4368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1771060
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: