Healthcare Provider Details

I. General information

NPI: 1801751300
Provider Name (Legal Business Name): NICOLE MELISSA GARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE MELISSA SONKE NP

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25095 HOMEDALE RD
WILDER ID
83676-5811
US

IV. Provider business mailing address

25095 HOMEDALE RD
WILDER ID
83676-5811
US

V. Phone/Fax

Practice location:
  • Phone: 208-695-8490
  • Fax:
Mailing address:
  • Phone: 208-695-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number99-4989751
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: