Healthcare Provider Details

I. General information

NPI: 1225020993
Provider Name (Legal Business Name): APRIL D SOUTHWICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: APRIL D KREITZER NP

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 02/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 S AMERICANA BLVD STE 130
BOISE ID
83702-5099
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-7500
  • Fax: 208-706-7501
Mailing address:
  • Phone: 208-381-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP482A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: