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General NPI Number Information
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NPI Number | 1689806663
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Entity Type | Individual
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Provider Name | STEPHANIE LYSSA HOPE CST
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Gender | Female
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 1075 N CURTIS RD SUITE 300
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City | BOISE
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State | ID
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Zip | 83706-1300
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Country | US
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Telephone | 208-323-2600
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Fax | 208-323-9172
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Provider Business Mailing Address
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Address Line | 8950 W EMERALD ST STE 168
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City | BOISE
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State | ID
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Zip | 83704-8296
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Country | US
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Telephone | 208-321-1209
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Fax | 208-321-1211
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 109240
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License Number State | ID
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