Provider Demographics
NPI:1669486502
Name:MOSHER, DOROTHY ELIZABETH (CFNP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ELIZABETH
Last Name:MOSHER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 N CURTIS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1348
Mailing Address - Country:US
Mailing Address - Phone:208-377-5166
Mailing Address - Fax:208-375-0599
Practice Address - Street 1:1075 N CURTIS RD STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1348
Practice Address - Country:US
Practice Address - Phone:208-377-5166
Practice Address - Fax:083-750-5992
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY20195.233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY117280800Medicaid
WY9578Medicare ID - Type Unspecified
WY117280800Medicaid