Healthcare Provider Details

I. General information

NPI: 1174427215
Provider Name (Legal Business Name): IAN REID ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 KANIKSU ST
BONNERS FERRY ID
83805-7532
US

IV. Provider business mailing address

6778 IVY LN
BONNERS FERRY ID
83805-6069
US

V. Phone/Fax

Practice location:
  • Phone: 208-267-4847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number7071273
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: