Healthcare Provider Details

I. General information

NPI: 1619562295
Provider Name (Legal Business Name): GARHETT J ULMER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 W CURTISIAN AVE STE 200
BOISE ID
83704-0107
US

IV. Provider business mailing address

PO BOX 381
KOOSKIA ID
83539-0381
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-0000
  • Fax:
Mailing address:
  • Phone: 208-935-5073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number55923
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number55923
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: