Healthcare Provider Details

I. General information

NPI: 1023767910
Provider Name (Legal Business Name): JUSTIN ARMSTRONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E PARKCENTER BLVD
BOISE ID
83706-6528
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-6500
  • Fax:
Mailing address:
  • Phone: 120-838-1874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number58505
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number58505
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: