IDAHO STATE UNIVERSITY NPI 1962095711

NPI Information

IDAHO STATE UNIVERSITY is a primary care nurse practitioner in Meridian, ID. IDAHO STATE UNIVERSITY NPI is 1962095711. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Isu Meridian Healthcare.

The provider's business location address is:

1311 E CENTRAL DR
MERIDIAN, ID
ZIP 83642-991
Phone: (208) 373-1734
Fax: (833) 499-1813

The provider's authorized official is Cynthia Lee Rock .
The authorized official title is Clinics Director Of Operations and has the following contact phone number (208) 373-1743.

The CLIA number assigned to this NPI record is 13D2228558 - other - isu facility clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/12/2021 and was last updated on 8/27/2021.

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:

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