MS. SUSAN M DERIVAS CNP NPI 1851493829

NPI Information

NPI: 1851493829
Provider Name: MS. SUSAN M DERIVAS, CNP
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
4055 E BLUEBERRY ST
MERIDIAN, ID
ZIP 83642
Phone: (208) 775-7418
Get Directions

MS. Susan M Derivas, CNP is a psychiatric/mental health nurse practitioner in Meridian, ID. MS. Susan M Derivas, CNP NPI is 1851493829. The provider is registered as an individual entity type and is a multi-specialty group.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4055 E BLUEBERRY ST
MERIDIAN, ID
ZIP 83642-261
Phone: (208) 775-7418
Fax: (208) 647-5008

The NPI 1851493829 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/1/2006 and was last updated on 2/7/2024.

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	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	64266	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	208-775-7418	OTHER		SPRUCE HEALTH
2	1032026	MEDICAID	IDAHO
3	5708247	OTHER	IDAHO	EVERNORTH
4	932434	OTHER		AVAILITY ID
5	0062-0104069	OTHER		UNITED HEALTHCARE SERVICES, PROVIDER NO.
6	13961493	OTHER		CAQH PROVIDER ID
7	909072	OTHER		CHANGE HEALTHCARE SUBMITTER ID
8	1851493829	OTHER		CLOZAPINE REMS CERTIFIED
9	396453	OTHER		MASTER BILLING ID (OSMIND)

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: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

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