MEDICARE: DR. RALENE WIBERG MD

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	NP464A	ID
2	207Q00000X	Family Medicine Physician	0101252362	VA
3	207Q00000X	Family Medicine Physician	M-12117	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP464A	OTHER	ID	NP LICENSE

General Provider Information

NPI Number	:	1912956806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALENE WIBERG MD

Provider Business Mailing Address
First Line	:	211 16TH AVE N
Second Line	:	PO BOX 9
City	:	NAMPA
State	:	ID
Zip	:	83687-4058
Country	:	US
Telephone Number	:	208-461-7149
Fax Number	:	208-467-3391

Provider Business Practice Location Address
First Line	:	211 16TH AVE N
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-4058
Country	:	US
Telephone Number	:	208-461-7149
Fax Number	:	208-467-3391

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	08/01/2013

Similar Medicare Providers

1003819509 — DR. JULIA MARIE JENSEN DO
Practice Location Address:

223 16TH AVE N
NAMPA, ID
83687-4058

Practice Phone: 208-466-7869
Practice Fax: 208-466-5359

1982696050 — RENEE B. RYDER NP
Practice Location Address:

223 16TH AVE N
NAMPA, ID
83687-4058

Practice Phone: 208-466-7869
Practice Fax: 208-466-5359

1366412595 — MR. DAVID T. FOSS FNP
Practice Location Address:

211 16TH AVE N
NAMPA, ID
83687-4058

Practice Phone: 208-467-4431
Practice Fax:

1457309122 — COMMUNITY HEALTH CLINICS, INC.
Practice Location Address:

223 16TH AVE N
NAMPA, ID
83687-4058

Practice Phone: 208-467-7654
Practice Fax: 208-466-5359

1811947526 — MS. SHARON M BALDWIN CNS
Practice Location Address:

207 16TH AVE N
NAMPA, ID
83687-4058

Practice Phone: 208-467-7654
Practice Fax: 208-318-1391

1053351361 — STUART BLACK M.D.
Practice Location Address:

223 16TH AVE N
NAMPA, ID
83687-4058

Practice Phone: 208-466-7869
Practice Fax: 208-466-5359

Directions to “ DR. RALENE WIBERG MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.