Provider Demographics
NPI:1154072205
Name:RANKIN, MARY HANNAH (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HANNAH
Last Name:RANKIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 W FLORENCE DR UNIT 104
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-8054
Mailing Address - Country:US
Mailing Address - Phone:740-646-6809
Mailing Address - Fax:
Practice Address - Street 1:1672 S WOODSAGE AVE STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8332
Practice Address - Country:US
Practice Address - Phone:208-515-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID703692084P0800X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry