Healthcare Provider Details

I. General information

NPI: 1841783099
Provider Name (Legal Business Name): SUMMER LYNN COCKAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST
BOISE ID
83702-4599
US

IV. Provider business mailing address

6340 S IRONWOOD AVE
BOISE ID
83709-1243
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1000
  • Fax:
Mailing address:
  • Phone: 208-284-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number58511
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: