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General NPI Number Information
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NPI Number | 1730962150
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Entity Type | Individual
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Provider Name | AMANDA DUPLISEA FNP
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Gender | Female
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 09/07/2024
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Provider Practice Location Address
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Address Line | 500 W FORT ST
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City | BOISE
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State | ID
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Zip | 83702-4501
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Country | US
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Telephone | 801-662-8540
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Fax |
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Provider Business Mailing Address
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Address Line | 6029 N HAMPSTEAD AVE
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City | BOISE
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State | ID
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Zip | 83714-2032
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Country | US
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Telephone |
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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 | 77027
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License Number State | ID
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