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General NPI Number Information
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NPI Number | 1750186581
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Entity Type | Individual
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Provider Name | ALLISON NICOLE CLARK NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 1000 N CURTIS RD STE 303
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City | BOISE
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State | ID
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Zip | 83706-1347
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Country | US
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Telephone | 208-377-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 406 S 4TH ST APT 615
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City | BOISE
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State | ID
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Zip | 83702-7743
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Country | US
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Telephone | 309-310-2521
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2571938
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License Number State | ID
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