MRS. RENEE M WILSON (NPI# 1215019534) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215019534 |
| Entity Type | Individual |
| Full Name | MRS. RENEE M WILSON |
| Credential | PA-C |
| Practice Address |
425 W Bannock St Boise ID 83702-6035 |
| Practice Telephone | 2083436458 |
| Practice Fax Number | 2083435031 |
| Mailing Telephone | 2083431702 |
| Mailing Fax Number | 2083427042 |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2019-07-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA557 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 807233200 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2235 E Gala St, Meridian, ID 836428026 | 2088873724 | 2088871682 |
| 9850 St Lukes Dr, Nampa, ID 836877912 | 2083436458 | 2083435031 |
| 1200 Garrity Blvd, Nampa, ID 836873402 | 2083436458 | 2083435031 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417308909 | Renee Tanya Wilson | Counselor | 5535 Harvard Rd, Detroit, MI 48224-2163 | 2016-06-26 |
| 1386885549 | Renee Nichole Wilson | Speech-Language Pathologist | 2301 Research Blvd Ste 110, Rockville, MD 20850-6250 | 2009-03-18 |
| 1467653014 | Renee D Wilson | Nurse Practitioner | 825 Graham Rd, Benton, AR 72015-8975 | 2007-05-30 |
| 1033202452 | Renee Proctor Wilson | Midwife | 1400 N Laventure Rd, Mount Vernon, WA 98273-2766 | 2006-09-30 |
| 1154949626 | Renee J Wilson | Counselor | 600 N Grand Ave, Tahlequah, OK 74464-2301 | 2020-07-10 |
| 1821599820 | Renee Bernice Wilson | Counselor | 806 Hay St, Fayetteville, NC 28305-5312 | 2018-02-24 |
| 1720528631 | Renee Wilson | Nurse Practitioner | 19415 Deerfield Ave, Suite 112, Lansdowne, VA 20176-8452 | 2017-02-27 |
| 1407229024 | Renee Marie Wilson | Physician Assistant | 1515 Holcombe Blvd, Houston, TX 77030-4009 | 2015-11-04 |
| 1780074492 | Renee Wilson | Pharmacy Technician | 7400 Bustleton Ave, Philadelphia, PA 19152-4312 | 2015-02-02 |
| 1750789590 | Renee Wilson | Social Worker | 30000 Hiveley St, Inkster, MI 48141-1089 | 2014-12-10 |
| Street Address |
425 W BANNOCK ST |
| City | BOISE |
| State | ID |
| Zip Code | 83702-6035 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184619165 | Paul H Baehr | Internal Medicine | 425 W Bannock St, Boise, ID 83702-6035 | 2005-09-15 |
| 1275145047 | Leah Stambaugh | Nurse Practitioner | 425 W Bannock St, Boise, ID 83702-6035 | 2020-08-21 |
| 1609334127 | Jessica Spring Snuffin | Nurse Practitioner | 425 W Bannock St, Boise, ID 83702-6035 | 2019-03-04 |
| 1679986400 | Christopher W Hammerle Md Chtd | Internal Medicine | 425 W Bannock St, Boise, ID 83702-6035 | 2014-06-10 |
| 1295177541 | Cory Andrew Shuler | Nurse Practitioner | 425 W Bannock St, Boise, ID 83702-6035 | 2013-07-26 |
| 1760774483 | Matthew R Sericati, M.d. Chartered | Internal Medicine | 425 W Bannock St, Boise, ID 83702-6035 | 2011-05-13 |
| 1588954101 | Robert Alanson Lockwood | Internal Medicine | 425 W Bannock St, Boise, ID 83702 | 2011-04-15 |
| 1023322856 | Laura Lela Hartwig | Nurse Practitioner | 425 W Bannock St, Boise, ID 83702-6035 | 2010-08-04 |
| 1447582580 | Regina M Hanson | Nurse Practitioner | 425 W Bannock St, Boise, ID 83702-6035 | 2010-01-30 |
| 1831429802 | Judith A. Woods, M.d., P.a. | Internal Medicine | 425 W Bannock St, Boise, ID 83702-6035 | 2010-01-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
| 1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
| 1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
| 1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
| 1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
| 1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
| 1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
| 1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
| 1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
| 1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
| Find all providers in zip 83702 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073915963 | Jessica Bishop | Physician Assistant | 1499 W Hays St, Boise, ID 83702-5029 | 2014-09-23 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1710231238 | Alaina A Mccoy | Physician Assistant | 100 E. Idaho St., Suite 400, Boise, ID 83712 | 2012-11-06 |
| 1447534821 | Addie Barnes | Physician Assistant | 900 N Liberty, Ste 101, Boise, ID 83704 | 2011-10-04 |
| 1134358104 | Eric Culbertson | Physician Assistant | 633n 4th St, Boise, ID 83702-4510 | 2009-07-10 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1598921595 | Karen B. Barrett | Physician Assistant | 6000 W. Overland Road, Firstline Medical, Boise, ID 83704 | 2008-07-30 |
| 1972672111 | Kara Mcgee | Physician Assistant | 727 E Riverpark Ln Ste 200, Boise, ID 83706-4097 | 2006-11-06 |
| 1265464036 | Sharene E Watsen | Physician Assistant | 403 South 11th St, Ste 100, Boise, ID 83702-6906 | 2006-07-06 |
| 1508802091 | Heidi R Munro | Physician Assistant | 8000 S Federal Way, Boise, ID 83716-9632 | 2006-06-22 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.