Healthcare Provider Details

I. General information

NPI: 1699409540
Provider Name (Legal Business Name): JOANNA DZIEWA APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 06/28/2024
Certification Date: 11/02/2023
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 190930
BOISE ID
83719-0930
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-0000
  • Fax: 208-302-0055
Mailing address:
  • Phone: 208-367-5170
  • Fax: 208-367-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number73476
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: