Provider Demographics
NPI:1265975494
Name:MULTANSKI, TESIA (RN)
Entity type:Individual
Prefix:
First Name:TESIA
Middle Name:
Last Name:MULTANSKI
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 1:2253 E ROANOKE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-7534
Mailing Address - Country:US
Mailing Address - Phone:208-761-6611
Mailing Address - Fax:
Practice Address - Street 1:500 W FORT ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4501
Practice Address - Country:US
Practice Address - Phone:208-422-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-20
Last Update Date:2022-11-01
Deactivation Date:2016-12-07
Deactivation Code:
Reactivation Date:2022-11-01
Provider Licenses
StateLicense IDTaxonomies
IDN-28805163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse