Healthcare Provider Details

I. General information

NPI: 1821788654
Provider Name (Legal Business Name): NATHAN TOENJES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 10/22/2026
Certification Date: 10/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 CENTER PARK DRIVE
AMMON ID
83406
US

IV. Provider business mailing address

2184 CHANNING WAY # 234
IDAHO FALLS ID
83404-8034
US

V. Phone/Fax

Practice location:
  • Phone: 208-557-1075
  • Fax: 208-266-5118
Mailing address:
  • Phone: 208-557-1075
  • Fax: 208-266-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4371582
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: