MEDICARE: MR. BENJAMIN ALEXANDER VAN HOOGEN FNP-C

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
1	363LF0000X	Family Nurse Practitioner	7971796	ID

General Provider Information

NPI Number	:	1255287041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN ALEXANDER VAN HOOGEN FNP-C

Provider Business Mailing Address
First Line	:	2323 S VISTA AVE STE 100
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83705-7343
Country	:	US
Telephone Number	:	208-250-3135
Fax Number	:

Provider Business Practice Location Address
First Line	:	2273 E GALA ST
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-7289
Country	:	US
Telephone Number	:	208-944-2354
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ MR. BENJAMIN ALEXANDER VAN HOOGEN FNP-C” Practice Location

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