ABUNDANT LIFE HEALTH CARE PC NPI 1386750552

NPI Information

NPI: 1386750552
Provider Name: ABUNDANT LIFE HEALTH CARE PC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 13D1062890

Address:
1617 W JEFFERSON ST
BOISE, ID
ZIP 83702
Phone: (208) 433-9188
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ABUNDANT LIFE HEALTH CARE PC is a family nurse practitioner in Boise, ID. ABUNDANT LIFE HEALTH CARE PC NPI is 1386750552. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1617 W JEFFERSON ST
BOISE, ID
ZIP 83702-111
Phone: (208) 433-9188
Fax: (208) 433-9372

The provider's authorized official is Karole L Beck .
The authorized official title is Family Nurse Practitioner and has the following contact phone number (208) 433-9188.

The CLIA number assigned to this NPI record is 13D1062890 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/21/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	NP-541A	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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