Provider Demographics
NPI:1821713520
Name:ABAQUITA, MARY JOE SAYCON (RN)
Entity Type:Individual
Prefix:
First Name:MARY JOE
Middle Name:SAYCON
Last Name:ABAQUITA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N AVENGER LN APT 102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-1752
Mailing Address - Country:US
Mailing Address - Phone:208-605-3000
Mailing Address - Fax:
Practice Address - Street 1:711 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1445
Practice Address - Country:US
Practice Address - Phone:208-605-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID68533163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID68533OtherNURSING LICENSE