Healthcare Provider Details

I. General information

NPI: 1356678106
Provider Name (Legal Business Name): CLEA K. MEFFORD RN MSN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 POMERELLE AVE # H
BURLEY ID
83318-2064
US

IV. Provider business mailing address

1408 POMERELLE AVE # H
BURLEY ID
83318-2064
US

V. Phone/Fax

Practice location:
  • Phone: 208-878-4970
  • Fax: 208-878-4974
Mailing address:
  • Phone: 208-878-4970
  • Fax: 208-878-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP-895A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: