Provider Demographics
NPI:1750397238
Name:BOULTON, CYNTHIA M (NP)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:M
Last Name:BOULTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 E HAWAII AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6011
Mailing Address - Country:US
Mailing Address - Phone:208-463-3000
Mailing Address - Fax:208-463-3079
Practice Address - Street 1:7272 W POTOMAC DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9149
Practice Address - Country:US
Practice Address - Phone:208-884-2922
Practice Address - Fax:208-463-3044
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4874524-4405363LF0000X
IDNP-1122A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1750397238Medicaid
ID1750397238Medicaid
ID20002208Medicare PIN