Basic Information
| Provider Information | |||||||||
| NPI: | 1477719433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRAPER | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 E GOLDSTONE WAY | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836421026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083026000 | ||||||||
| FaxNumber: | 2083026055 | ||||||||
| Practice Location | |||||||||
| Address1: | 323 E RIVERSIDE DRIVE | ||||||||
| Address2: | STE 224 | ||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836166815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083026000 | ||||||||
| FaxNumber: | 2083026055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2008 | ||||||||
| LastUpdateDate: | 11/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | NP873A | ID | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.