License holder summary

MIAH NYSTROM is a Board Of Medicine licensed to practice in Idaho. The address on file for MIAH NYSTROM is 1910 UNIVERSITY DR BOISE ID 83725. This licensed professional license is not current. The license was granted 04/28/2014 and expired on 09/15/2015.

Idaho

Division of Occupational and Professional Licenses

MIAH NYSTROM
Board Of Medicine
License number
RTS-658
Date granted
04/28/2014
Date expires
09/15/2015
Class
Board Of Medicine
Status
Expired
Address
1910 UNIVERSITY DR BOISE ID 83725
idaholicensing.com
ID 48360899
LAST UPDATED 2024-03-19 08:55:25 UTC

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