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General NPI Number Information
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NPI Number | 1225813595
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Entity Type | Individual
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Provider Name | TRAVIS BLASER FNP
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Gender | Male
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 4305 N EAGLE RD
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City | BOISE
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State | ID
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Zip | 83713-4722
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Country | US
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Telephone | 208-939-3110
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Fax |
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Provider Business Mailing Address
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Address Line | 8454 N PIERCE PARK RD
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City | BOISE
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State | ID
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Zip | 83714-2505
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Country | US
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Telephone | 608-780-2742
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 77386
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License Number State | ID
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