Healthcare Provider Details

I. General information

NPI: 1144325572
Provider Name (Legal Business Name): ANNIE C FIFE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W. FORT ST
BOISE ID
83702
US

IV. Provider business mailing address

2787 STONY FORK WAY
BOISE ID
83706
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-7760
  • Fax: 208-422-1243
Mailing address:
  • Phone: 208-383-9059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP-260A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: