Healthcare Provider Details

I. General information

NPI: 1669063384
Provider Name (Legal Business Name): TREVOR SPENCE NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N SAWGRASS WAY
BOISE ID
83704-4493
US

IV. Provider business mailing address

5373 W MILANO DR
MERIDIAN ID
83646-7603
US

V. Phone/Fax

Practice location:
  • Phone: 208-375-2658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95016395
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53451
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: