Healthcare Provider Details

I. General information

NPI: 1346406287
Provider Name (Legal Business Name): REBECCA LYNN DEPPEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST
BOISE ID
83702-4501
US

IV. Provider business mailing address

13542 W TILLI RD
MOUNTAIN HOME ID
83647-5009
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1000
  • Fax:
Mailing address:
  • Phone: 208-796-2250
  • Fax: 208-796-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberN-23384
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: