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NPI Code Detail

MEDICARE: NICOLE K WHITING

MEDICARE: NICOLE K WHITING
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramPSB94028303CA
2390200000XStudent in an Organized Health Care Education/Training ProgramSE-203972ID

General Provider Information

NPI Number : 1174358956
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE K WHITING
Provider Business Mailing Address
First Line : 1047 SCHULTZ RD
Second Line :
City : MOSCOW
State : ID
Zip : 83843-8120
Country : US
Telephone Number : 208-310-1261
Fax Number :
Provider Business Practice Location Address
First Line : 1065 E WINDING CREEK DR STE 250
Second Line :
City : EAGLE
State : ID
Zip : 83616-7246
Country : US
Telephone Number : 208-805-2324
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2024
Last Update Date : 09/03/2024

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Directions to “ NICOLE K WHITING ” Practice Location

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