Healthcare Provider Details

I. General information

NPI: 1942160007
Provider Name (Legal Business Name): DAWN MARIE NEILL APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 N ALLUMBAUGH ST STE 101
BOISE ID
83704-9219
US

IV. Provider business mailing address

808 SW 8TH ST
FRUITLAND ID
83619-2527
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-1125
  • Fax:
Mailing address:
  • Phone: 208-365-8557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3971880
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: