Provider Demographics
NPI:1942201520
Name:CURTIS, MARY A (APRN,BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:CURTIS
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 E BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6167
Mailing Address - Country:US
Mailing Address - Phone:208-939-6782
Mailing Address - Fax:
Practice Address - Street 1:8100 W EMERALD ST
Practice Address - Street 2:SUITE 150
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9055
Practice Address - Country:US
Practice Address - Phone:208-375-0752
Practice Address - Fax:208-375-0796
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN21382364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health