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General NPI Number Information
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NPI Number | 1144950353
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Entity Type | Individual
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Provider Name | AMY L BACCA APRN AGCNS-BC
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Gender | Female
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 720 E PARK BLVD STE 260
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City | BOISE
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State | ID
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Zip | 83712-7765
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Country | US
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Telephone | 208-381-6879
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 N STRATFORD DR
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City | BOISE
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State | ID
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Zip | 83704-3356
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Country | US
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Telephone | 208-447-7138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 67616
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License Number State | ID
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