Healthcare Provider Details

I. General information

NPI: 1467854109
Provider Name (Legal Business Name): MATTHEW WEBB APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 07/04/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 S DEVELOPMENT AVE
BOISE ID
83705-5354
US

IV. Provider business mailing address

3833 S DEVELOPMENT AVE
BOISE ID
83705-5354
US

V. Phone/Fax

Practice location:
  • Phone: 208-387-5280
  • Fax:
Mailing address:
  • Phone: 208-387-5280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11006402
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number70118
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 228872
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006402
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPMD 526814
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number8557
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 9381306
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number70118
License Number StateID
# 9
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 228872
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: