Healthcare Provider Details

I. General information

NPI: 1679971741
Provider Name (Legal Business Name): TRISHA WINEMAN WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6259 W EMERALD ST
BOISE ID
83704-8731
US

IV. Provider business mailing address

3463 W BRENEMAN ST
BOISE ID
83703-5559
US

V. Phone/Fax

Practice location:
  • Phone: 208-489-1900
  • Fax: 208-388-1996
Mailing address:
  • Phone: 541-490-3919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number61699
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number61699
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number61699
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: