Healthcare Provider Details

I. General information

NPI: 1336378124
Provider Name (Legal Business Name): THOR HAUFF FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4971 W OVERLAND RD
BOISE ID
83705-2822
US

IV. Provider business mailing address

PO BOX 191050
BOISE ID
83719-1050
US

V. Phone/Fax

Practice location:
  • Phone: 208-472-5050
  • Fax: 208-472-5051
Mailing address:
  • Phone: 208-955-6500
  • Fax: 208-955-6503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1160A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberN-26795
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: