Provider Demographics
NPI:1992562243
Name:MAIER, ELYSIA (BA)
Entity type:Individual
Prefix:
First Name:ELYSIA
Middle Name:
Last Name:MAIER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:ELYSIA
Other - Middle Name:MAREN
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:921 S ORCHARD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1916
Mailing Address - Country:US
Mailing Address - Phone:208-344-9797
Mailing Address - Fax:208-344-9898
Practice Address - Street 1:921 S ORCHARD ST STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1916
Practice Address - Country:US
Practice Address - Phone:208-344-9797
Practice Address - Fax:208-344-9898
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator