Provider Demographics
NPI:1518592674
Name:GILLETTE, AMBER LYNN (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44953
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-0953
Mailing Address - Country:US
Mailing Address - Phone:986-224-8424
Mailing Address - Fax:208-504-2821
Practice Address - Street 1:1111 S ORCHARD ST STE 251
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1964
Practice Address - Country:US
Practice Address - Phone:208-965-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID63220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily